Clifton Park Water Authority - CPWA

Applicant*

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Address*

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Your Email*

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Phone*

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Lic. Plate No.*

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Use of Water

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Start Date*

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Expiration Date*

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Backflow Prevention (Choose One)*

Air Gap

Double Check Valve

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Permit Requested*

Less than 1,000 Gallons $500.00/year

Between 1,001 and 2,000 Gallons $750.00

Between 2,001 and 3,000 Gallons $1,000.00

Over 3,000 Gallons $1,250.00

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Temporary Permit (10 Day Maximum/ 1 Day Minimum):

Temporary $100.00/day Invalid Input

Total Permit

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By Signing below the permitee agrees that he has read and understands the Hydrant Use Regulations of the Clifton Park Water Authority as adopted by the Clifton Park Water Authority Board of Directors.

Signature (Please type in full name)*

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Today's Date*

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PERMITTED HYDRANTS: Boyack Road & Tanner Road at Route 146A, unless otherwise permitted by the CPWA.

Specially Authorized Hydrant #/Location

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*

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Submit

Application for Fire Hydrant Permit