Water Service Application

Project Information:

Name(Required)

First Last

Phone(Required)

Service Address(Required)

Street Address Address Line 2 City State ZIP Code

Parcel Number(Required)

Type of Service(Required)

Other Service(Required)

Type of Structure(Required)

Permanent

Mobile

Travel Trailer

Other

Other Type of Structure(Required)

Desired Service Date(Required)

Meter Box Already Installed?(Required)

Yes

Meter Size(Required)

Standard 5/8"

Other

Other Meter Size(Required)

I hereby request service as noted above. I understand that I must submit the following fees in advance of service:

System Development Charge (SDC)(Required)

Meter Charge(Required)

Full Install (Meter Cost Included)(Required)

Other Charge (Description)

Other Charge (Fee)

Total Fees

I understand that I will be required to provide my own plumbing from the water meter or sewer connection to the buildings(s). Specific system regulations may specify the type and size of plumbing fixtures required. All systems are governed by general and specific policies, rules, and regulations and I hereby agree to said policies, rules, and regulations. Copies of District policies are available upon request. The District office must be notified of time and date of hookup to ensure that District personnel can be present for inspection.

Please submit a plot plan showing measurements, locations of buildings and any other information. Any questions or concerns please call 360-385-5800.

Additional Files/Documents

Drop files here or

Max. file size: 128 MB.

Authorized Signature(Required)

Date(Required)

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