Township of Selwyn

Water and Sewer: Release Form - Water Service Shut Down/Restoration 

Please use this form to:

• Request water service shut down
• Request water service restoration

Billing Details:

A $10.00 service fee applies to all service shut downs and restorations. 

When the shut down is completed, a bill will be generated that includes:

• The $10.00 shut down fee
• Billing for the period since the last billing to the date of the shut-down

When the restoration is completed, at the time of the next regular billing, a bill will be generated that includes:

• The $10.00 restoration fee
• Billing for the period since the restoration to the end of the regular billing period.

You will be responsible for payment of this bill by the due date, or penalty will be processed and the fees added to the property tax roll for collection. Payment arrangements or mail forwarding should be in place prior to an absence from the property. 

By signing below I acknowledge that the Township of Selwyn advises that no valve is necessarily watertight, and the Township of Selwyn cannot guarantee a watertight shutdown of the water service.

By signing below I acknowledge that the Township of Selwyn accepts no responsibility for any loss, damage, claim or other liability however risen, suffered by the owner or any other party, in connection with the water service shut down/restoration.

Personal information on this form is collected under the authority of the Municipal Act 2001, and will be used to process billings, and to authorized a water service shut down/restoration. The personal information submitted will be used to provide you with information or updates on services or activities that the Township of Selwyn delivers under the Municipal Act or other legislation. Questions about the collection of this personal information should be directed to the Clerk.