Water Department Sturgis Water Department Release ... - City of Sturgis

Sturgis Water Department Release of Responsibility for Water Turn On I, _____________________________________, (please print) am requesting that my water be turned on at the following address _________________________________________ (please print) by the Sturgis Water Department. I understand any damage done due to water damage will be my responsibility _______ (initial) and I agree not to hold the City of Sturgis or the Water Department responsible for any damages to the property or structure listed above by me _______ (initial), the renter or owner of that property. I also understand that I am only asking the Sturgis Water Department to turn on my water from a City controlled valve and that no City employee will check the inside of the house, structure, or property for open valves, faucets or closed drains. I also understand that payment on all utility charges and fees must be current before the water will be turned on. I agree to the above conditions and agree to hold the Sturgis Water Department blameless of any water damage that results from the water being turned on by the Water Department Employee on the dates of ___________. Signature

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Water Department Witness Signature This release form must be received before your water will be turned on. Please drop off or mail to the address listed below. Updated 4/2014

Water Department 1040 2nd Street, Suite 103, Sturgis, SD 57785 • (605) 347-4425 • Fax: (605) 347-4861 www.sturgis-sd.gov “In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, age, disability, religion, sex, familial status, sexual orientation, and reprisal. (Not all prohibited bases apply to all programs.)