Roanoke Rapids Sanitary District's Online Service Application Portal
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Utility Service Application
Utility Service Application
Applicant Information
Check here if you are currently a customer of at another address:
Current Account:
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Create Cut-off Service Order for Current Account?
Requested Turn Off Date:
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Requested Turn Off Time:
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Social Security Number
Enter last 4 digits of SSN:
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Please indicate type of account:
Residential:
Business:
Business Name:
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First Name:
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Middle Name:
Last Name:
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Date of Birth:
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Home Phone:
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Mobile Phone:
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Federal ID:
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Work Phone:
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Email:
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Driver's License:
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SSN:
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Gender:
Ethnicity:
Race:
Name:
Home Phone:
Mobile Phone:
Work Phone:
Email:
*
Date of Birth:
*
Driver's License:
SSN:
Relationship:
Remove Co-Applicant
Please enter the address for which you are requesting service.
Address:
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City:
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State:
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Zip Code:
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Check if you own this residence:
Name of mortgage company: Name of landlord:
Check if your billing address is same as the service address:
If not, please enter your billing address
Address:
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State:
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City:
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Zip Code:
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Address:
City:
State:
Zip Code:
Requested Turn on Date for Utilities:
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Requested Turn on Time for Utilities:
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Name:
*
Phone No:
*
Address:
City:
State:
Zip Code:
Additional Comments:
Please attach required documents here:
Drag file here
Current Image:
Check here if you are currently a customer of at another address:
Current Account:
Create Cut-off Service Order for Current Account
Requested Turn Off Date:
Requested Turn Off Time:
Type of account:
First Name:
Middle Name:
Last Name:
Business Name:
Date of Birth:
Home Phone:
Mobile Phone:
Work Phone:
Email:
Driver's License:
SSN:
Federal ID:
Co-Applicant Information:
Name:
Home Phone:
Mobile Phone:
Work Phone:
Email:
Date of Birth:
Driver's License:
SSN:
Relationship:
Service Address:
Address:
State:
City:
Zip Code:
Check if you own this residence:
Name of mortgage company: Name of landlord:
Check if your billing address is same as the service address:
If not, please enter your billing address
Address:
State:
City:
Zip Code:
Previous Address:
Address:
State:
City:
Zip Code:
Requested Turn on Date for Utilities:
Requested Turn on Time for Utilities:
Name:
Address:
State:
Phone No:
City:
Zip Code:
Additional Comments:
By clicking Submit, you hereby petition the Roanoke Rapids Sanitary District (RRSD) to turn on water at the Service Address. The owner or renter (Customer) hereby specifically represents that all hot water heaters, spigots and valves affecting the plumbing or water lines in the building(s) at the premises are closed; that all pipelines and plumbing in said building(s) are in good working condition and hereby specifically request the RRSD to turn said water on at Service Address in Customer's absence and in the absence of any and all family member(s) or other representative(s), and that any damages to building and property therein resulting from water being turned on as aforesaid by the RRSD, it being fully understood that the RRSD shall not be liable for said damages, if same occur. Further, the Customer grants to the RRSD the right, privilege, and easement of right-of-way of sufficient width to locate, construct, maintain, repair and/or replace water and/or sewer pipe lines or appurtenances desirable in connection therewith across the lands and access as necessary to conduct the business of the RRSD. Only employees of the RRSD are authorized to control the flow of water at meters. The Customer agrees the RRSD may collect for non-payment through the NC Local Government Debt Setoff Clearinghouse Program by providing their social security number for account identification. The property owner is responsible for the water tap pipe from the meter to the structure and is also responsible for the sanitary sewer lateral pipe from the main tap in the street or alley to the structure. The Customer further agrees to adhere to the policies, regulations and ordinances of the RRSD. Submission also confirms that the applicant is 18 years of age or older, and that all information provided by them is accurate. If it is deemed necessary that you install a backflow prevention assembly appropriate for the designated use prior to water being turned on to property; a Backflow/Cross-connection Inspector will contact you within 24 business hours to provide you with additional information. Once your information is submitted, a Customer Service Representative will contact you within 24 hours during normal business hours. Services are connected during normal weekday business hours.
Your application has been submitted. You will receive a notification whether it has been denied or approved once it has been processed and completed.
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