**Please note owner of parcel MUST be Applicant, verified through current ownership from Larimer County Assessor and sign all District forms.**

If the Name on the Applicant is different than Assessor record, a signed written authorization (Statement of Authority) from current owner must be completed separately.

Submit a notarized copy of the Statement of Authority with the application to: communications@sfcsd.net

Name of Applicant (required)

Mailing Address of Applicant (required)

Contact Name (required)

Contact Phone Number (required)

Contact Email (required)

Tap City (required)

Tap Street Address (required)

Tap Zip Code (required)

Lot Number (required)

Block Number (required)

Filing Name (required)

Parcel Number (required)

Parcel Owner Name (must match Larimer County Assessor) (required)

Tap Account Type (required)ResidentialCommercialMulti-Family Residential

If Multi-Family, Enter number of Units

Water Tap size (required)3/4"1"1.5"2"3"4"6"

Raw Water Provider (required)Fort Collins-Loveland Water DistrictCity of Fort Collins

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Office Use Only:

Pmt Date: _________  Check No:__________ Sewer Acct. No:_____________

Service Type: _______ Basin:_____________  Sub-Basin:______________

Engineering Approval Date and Initial:_____________________

Tap Value $:____________    Finance Approval Date and Initial:_________________