Water & Sewer Owner’s Authorization Sheet

Owner's Authorization Sheet
Benton Water & Sewer Department
1403 South Main Street - Benton, IL 62812
Bus: 618-439-6131 Fax: 618-435-2610

Name of owner:
Owner's address:

Renter/Renter's Name(s):
Rental Address:

The above named individual(s) has rented property from me on

Submission of this form authorizes the Benton Water & Sewer Department to connect water and sewer service to the rental address mentioned above. This notice in no way relieves you of your liability under Benton Municipal Code Chapter 38 Section 38-2-2, which states:

38-2-2 Liability of Charges: The owner of the premises, the occupant thereof and the user of the utility service shall be jointly and severally liable to pay for the services to such premises and the utility services are furnished to the premises by the City only upon the condition that such owner of the premises, occupant and user are jointly and severally liable therefore to the City.
This authorization sheet must be received in the Benton Water and Sewer Department Office before service can be turned on at the residence and must be signed by the property owner in the presence of the City of Benton Water Department Clerk, or notarized.
If ownership of the property changes, the Water Office should be notified of the change and the date in order to change the records.

I, (Renter) acknowledge that the Owner has the right to access any and all information concerning my account for provision of service provided by this agreement.