New Owner Application Application for Customer Account Date of Application MM slash DD slash YYYY Service Start Date MM slash DD slash YYYY Date Escrow Closed MM slash DD slash YYYY Service Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Ownership InformationOwner's Name* First Middle Initial Last Co-Owner's Name First Middle Initial Last Mailing Address(if different than Service Address) Same as previous Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Owner's Email Address* Please indicate, in order of importance, the telephone numbers where you can be reached during normal business hours.Phone 1*Ext Phone 2Ext Phone 3Ext FaxOwner's Place of Work Co-Owner's Place of Work Owner's Drivers License # State Co-Owner's Drivers License # State Previous Account # in District Former Address CertificationBy signing this application, we agree to conform to all District ordinances, policies and procedures regarding water services. We understand and agree that water service may be discontinued for violation of these rules and for failure to pay in full the bill for water services by the due dates for each billing period. We have read and understand the following statements regarding service: The property owner is responsible for all plumbing, equipment and appliances from the point of connection to the District's system, which is typically located at the water meter connection. The property owner is responsible for any damage to District equipment and facilities resulting from acts of the owner, tenants, agents, employees, contractors, licensees or permittees. The property owner agrees that the District shall not be responsible or liable for damages or injuries resulting from interruption in service, changes in water pressure or quality of water or other unforeseen conditions or circumstances. It is understood that the District offers no guarantees, warranties or assurances regarding utility services and the quality of the water provided. The property owner is responsible for maintaining unrestricted and unobstructed access at all times to District water meters and other District equipment and facilities located on their property. Access that is restricted by an obstruction shall be remedied by the property owner at their sole expense. If the property owner fails to remove the obstruction or restriction within 30 calendar days of written notification, the District may remedy the restriction or obstruction and any costs incurred shall be the sole responsibility of the property owner. The property owner agrees to pay to the District, all charges and rates for the service provided pursuant to this application, including any costs related to the collection of amounts due. Under the California Water Code (Sections 22284 and 25806), the property owner is responsible for all unpaid amounts owed to the District resulting from service provided to the premises. The property owner agrees that tampering with water meters or other District equipment and facilities is a punishable offense under Section 498 of the Penal Code of the State of California. The property owner agrees that by applying for or receiving water service from the District, said owner irrevocably licenses the District and its authorized employees and representatives to enter upon the property owner's land at all reasonable times for the purpose of reading, inspecting, testing, checking, repairing, maintaining, or replacing the District's meters, District-owned water services, and water system components. I certify that I understand and agree with the above statements regarding water service.Owner's Signature Date MM slash DD slash YYYY Co-Owner's Signature Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ SIGN UP FOR ONLINE BILL PAY TODAY! GO PAPERLESS NOW
