Service Providers :: Form Types :: Lakeway Municipal Utility District

The following form must be completed for each assembly tested. A signed and dated form must be submitted to the public water supplier for recordkeeping purposes.

Please print, fill out and send to LMUD by e-mail ([email protected]) or drop it off at our office:
1097 Lohmans Crossing, Lakeway, TX 78734

Please call us if you have any questions: (512) 261-6222 ext. 110

Blank Form_TCEQ-20700_Updated20190404-2

STOP! Before filling out this form, please call our main office at (512) 261-6222 ext. 110 to confirm your location is serviced by Lakeway MUD.

If you prefer, you may instead print and mail or deliver this form. [ Printable Version ]
Before initiating service, please review our rates [ Printable Version ]
If you would like to set up auto payments, please use this form [ Printable Version ]
Date Service is Requested to Begin
Date Service to Begin*
Please schedule service start date Mon. – Fri. only, excluding holidays. Allow at least 1 (one) business day lead time.
(If you are part of the ODWW Project, please enter 9/9/9999)
MM slash DD slash YYYY
Billing for water and wastewater services will commence on the service start date, whether or not the property is occupied. The first billing will be prorated over the number of days the service was active. For new construction, billing for services will commence when the water meter is set. This includes water volume usage, plus water and wastewater base charges, plus minimum volume charge of 6,000 per month for wastewater. See Winter Averaging or our Rate Order for details.
Customer Information
Customer #1 Name*
First Middle Initial Last
Identification
- Social Security #
- Driver's License #
- Other Government Issued ID # and Description
Social Security #
Driver's License #
State of Issuance
Other Government Issued ID # and Description
Do you have a Co-Applicant?
- Yes
- No
Customer #2 Information
Customer #2 Name*
First Middle Last
Identification
- Social Security #
- Driver's License #
- Other Government Issued ID # and Description
Social Security #
Driver's License #
State of Issuance
Other Government Issued ID # and Description
Service Address
Service Address*
Street Address Address Line 2 City State Zip Code
Telephone (Main)*
Telephone (Alternate)
Email*
Billing Address
Billing Address
Same as Service Address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Payment
LMUD accepts payments made by credit card or debit card (one-time or automatically recurring), personal check, cashier’s check, money order, bank draft (one-time or automatically recurring), or on-line. A return item feewill be assessed if payment is rejected. A late fee may also be assessed.
Paperless (Emailed) Billing Requested
If yes, provide a valid email address under the Customer Information section, above
- Yes
- No
Automatically Recurring Payment Requested
- Yes
- No
Complete the Authorization for Automatic Payments form and return it to LMUD.
Lakeway Municipal Utility District
Administrative Office
1097 Lohmans Crossing
Lakeway TX 78734-445
Fax: (512) 261-6681

Please do not submit this form via email.
Customer Obligations
All Customers:
Customer must pay a nonrefundable Service Fee, which is due at the time of submittal of an Application and Service Contract. In addition, once service commences, Customer must pay all rates, fees, and charges and comply with all rules and regulations of LMUD now existing or as may be revised in the future.
Water Customers:
Customer shall install, at Customer’s own expense, a tap (if no tap is preexisting), a water service line commencing at LMUD’s water meter and connecting to the Customer’s home or place of use, and a cut-off valve. Customer shall be fully responsible for the service line from the water meter to Customer’s home or place of use, including the installation of an approved back-flow device if required. Tampering with LMUD’s water meter or using LMUD’s water cutoff valve is prohibited.
Wastewater Customers:
Customer shall install, at Customer’s expense, a tap (if no tap is preexisting) and aback-up relief valve, and must request inspection of same by LMUD after installation. More information is available on LMUD’s website at: https://lakewaymud.org/service-providers/guideline-requirement-documentation/wastewater-back-up-relief-valve-installation-guide.
Is there a grinder pump at the Service Address?*
- Yes
- No
- Unsure
Customers with a grinder pump at their property are required to fill out a Grinder Pump System Service and Maintenance Addendum.
Important Note: If a grinder pump is present or required, LMUD will provide maintenance per the FY 2019/2020 Rate Order update.

For LMUD-installed grinder pumps, additional installation fees may apply.

For customer-installed grinder pumps, some repairs may require additional fees.

For all customers with a grinder pump, please call us to request a work order for maintenance to be performed
General Terms of Service
After approval of this Service Contract by LMUD, LMUD will sell and deliver water and/or wastewater to the Customer, and the Customer shall receive and pay for such service(s) in accordance with LMUD’s most current Rate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion. As evidenced by its signature below, Customer expressly agrees to comply with and be bound by Lustrate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion, and agrees to the imposition and payment of fines and penalties for noncompliance.

LMUD has the authority to discontinue service to any Customer not complying with Lustrate Order, policies, rules, or regulations, or for non-payment of utility fees and other Mischarges. If service is discontinued, service will not be re-established until Customer has corrected all conditions that caused the termination. In some cases, a new Application for Service and Contract for Service must be submitted.
Rates, Fees, and Charges
LMUD’s rates, fees and charges shall be those adopted by the LMUD Board of Directors in its Rate Order, which may be revised from time to time by LMUD’s Board of Directors in its sole discretion. A brief summary LMUD’s current rates, fees and charges fees are available at LMUD’s Administrative Offices and on-line.
Easement
By the signature(s) below, the Customer(s) hereby grant(s)to LMUD any easements or rights-of-way required for the purpose of installing, inspecting, maintaining, and operating pipelines, meters, valves and any other equipment that may be required to extend or improve service by LMUD to Customer.
Notice of Right of Confidentiality
Section 182.052 of the Texas Utilities Code requires LMUD to notify customers of their right to confidentiality. You are hereby informed that you have the right to request confidentiality of your address, telephone number, social security number and any information relating to the volume or units of utility usage and the amounts billed to or collected from you for utility usage, as contained in LMUD’s records. To exercise your rights, please complete the Notification of Right of Confidentiality of Customer Information and return it to LMUD.
Customer Certification and Signatures
By my/our signature(s) below, I/we hereby certify the information provided herein and following statements are true and correct:
I/we am/are the*
- Owner
- Lessee
of the property located at the Service Address listed above [referred to as the "Customer" herein]. Customer desires to contract with Lakeway Municipal Utility District (LMUD) to receive water and/or wastewater service from LMUD to the property located at the Service Address listed above.
Customer hereby agrees to pay all rates, fees, and charges and to comply with all Rate Orders, other orders, rules, regulations, codes, and guidelines of LMUD now existing or as may be revised by LMUD in the future in LMUD’s sole discretion. Customer further agrees to comply with and be bound by LMUD’s Rate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion, and agrees to the imposition and payment of fines and penalties for noncompliance

CUSTOMER AGREES TO WAIVE, RELEASE, AND HOLD LMUD HARMLESS FROM ANY CLAIMS AND DAMAGES RESULTING FROM MALFUNCTION, FAILURE, OR ABSENCE OF CHECK VALVES, BACKFLOW PREVENTION DEVICES, AND PRESSURE RELIEF VALVES, INCLUDING WITHOUT LIMITATION, DAMAGES TO PERSONSOR PROPERTY, DIRECT DAMAGES, SPECIAL DAMAGES, INCIDENTAL DAMAGES, CONSEQUENTIAL DAMAGES, OR LOSS OF PROFIT OR REVENUE.

This Agreement shall become effective when signed by a duly authorized representative of LMUD
Customer Signature*
Name*
First Last
Customer Initials
Date*
MM slash DD slash YYYY
Customer #2 Signature
Customer #2 Name
First Last
Customer #2 Signature Date
MM slash DD slash YYYY
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Application for Easement Release

Service Providers

Application for Easement Release

Backflow Prevention Assembly Test & Maintenance Report

Notice to Purchasers

Application and Service Contract for Water and/or Wastewater Services

Date Service is Requested to Begin

Customer Information

Customer #2 Information

Service Address

Billing Address

Payment

Customer Obligations

General Terms of Service

Rates, Fees, and Charges

Easement

Notice of Right of Confidentiality

Customer Certification and Signatures

Complete Application For Plumbing Permit

Instructions

Applicant Information

Service Address Owner Information

Plumber Information

Addresses

Plumbing Service to be Performed

Plumbing Permit Required

Plumbing Standards

Additional Water and Wastewater Requirements

Permit and Inspection Fees

Inspection Scheduling and Project Close Out

Applicant Signature and Certification

Applicant

Lakeway Municipal Utility District

Customer Support

Quality Matters