Water Use Application - City of Vesta

Application For Water/Sewer/Garbage Service

Contact Us

Date*
MM slash DD slash YYYY
Name*
First Last
Number of Persons In Household*
Heat Source*
Service Address*
Street Address
Phone*
Email*
Enter Email Confirm Email
Date Service Requested to Begin*
MM slash DD slash YYYY
If the Owner of the Property is different that the person responsible for paying the bill enter their information here.
Refuse and recycling services are mandatory. Recycling pick up is every other Thursday, and Refuse pick up is on Thursdays. Every household is provided a green/yellow recycling cart from Waste Management. Cost for this service is included with property taxes. Refuse carts are available in three sizes at the following rates, which include State Tax. 35 Gallon Cart-$11.12 65 Gallon Cart-$14.99 95 Gallon Cart-$18.25 Bags for refuse overflow are available at $2.41 + Tax each from the City Clerk’s Office
Garbage Cart Size*
APPLICANT DATA RECORD Please provide the following information so that the City of Vesta will be in compliance with title VI of the Civil Rights Act of 1964. In order to meet the requirements of the Federal Register Vol. 62 No. 210, Revision to the Standards for the Classification of Federal Data on Race Ethnicity, all application forms for city utility connections must include below the signature and date block the following disclosure statements. Please select the appropriate information below:
Racial Categories*
- American Indian or Alaskan Native
- Asian
- Black or African American‎
- Native Hawaiian or Pacific Islander
- White‎
Ethnic Categories*
- Hispanic or Latino‎
- Not Hispanic or Latino‎
Gender*
- Male‎
- Female‎
The City Of Vesta is an Equal Opportunity Provider and Employer “The following information is requested by the Federal Government in order to monitor compliance with the Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note race/national origin of individual applicants on the basis of visual observation or surname”.

If you feel you have been discriminated against: To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TTD).
Signature*