2. Contact Information
4. Applicant's Name (First and Last)*
5. Email Address*

   The response to your request will be emailed to you.

7. Company or Business

   (If Applicable)

8. Phone Number*
10. Mailing Address*
12. City*
13. State*
14. Zip*
18. Information for Requested Service Location
20. Property Street Address*
21. Property Appraiser Parcel number(s) or "PIN" number(s)*
23. Subdivision/Lot#(s)/Block#(s)

    (If Applicable)

24. Building Floor or Unit Number(s)

    (If Applicable)

28. Utility Services Being Requested
30. What services do you need?

    (Select all that apply)

    1. Domestic (Potable) Water
    2. Landscape Irrigation Water

    1. Sanitary Sewer
    2. Fire Sprinkler Water

    1. Other Water Service
32. Meter Size (Domestic-Potable)

    1. 3/4-inch (typical residential service)
    2. 1-inch
    3. 2-inch
    4. 3-inch
    5. 4-inch
    6. 6-inch
    7. 8-inch
33. Tap Size (Fire Sprinkler)

    1. 2-inch
    2. 4-inch
    3. 6-inch
    4. 8-inch
    5. 10-inch
    6. 12-inch
35. Meter Size (Landscape Irrigation)

    1. 3/4-inch (typical residential service)
    2. 1-inch
    3. 2-inch
    4. 3-inch
    5. 4-inch
    6. 6-inch
    7. 8-inch
36. Annualized Average Daily Flow for Landscape Irrigation

    Not needed for one Single-Family Residential lot

37. Current City Water Account Number

    If requesting to add Sewer service to an existing Water account.

39. Meter Size (Other Water Service)

    1. 3/4-inch
    2. 1-inch
    3. 2-inch
    4. 3-inch
    5. 4-inch
    6. 6-inch
    7. 8-inch
    8. 10-inch
40. Describe Other Water Service Use
41. Annualized Average Daily Flow (Other Water Service)
45. Reason for Utility Request
47. Why are you requesting utilities?

    1. Existing Building
    2. Existing Building Currently Connected to City Utilities
    3. Existing Building Currently on Private Well or Septic

    1. New Construction: Replacement Building
    2. New Construction
49. Request

    1. Combine Service
    2. Separation of Service
50. Account Number on Current City Utility Bill
52. Street Address(es) of Existing Water Meter(s)
54. Street Address(es) proposed for New Water Meter(s)
56. Circumstance

    1. Addition
    2. Alteration
    3. Change-of-Use
    4. Service Upgrade / Change
57. Current City Account Number
58. Existing Square Footage
59. Proposed Square Footage
61. Requesting First-Time Connection to

    1. City Sewer
    2. City Water
65. Specific Proposed Use of Property or Building Where Utility Service is Requested
67. What type of building is your request for?

    1. Non-Residential Use

    1. Residential Use
69. Additional Information?

    Please enter all additional information pertaining to the services requested or the location of the requested services.

71. File Upload (Optional)

    Please upload any files that are relevant to services being requested or the location of the requested services.

72. Letters will typically be generated within 3 business days, to 2 weeks, from date of inquiry. Please allow time for this process.

    Submitting this request form does not guarantee service and does not commit the applicant to any further action. Incomplete or inaccurate information may cause delays. Changes to the information provided by applicant may void the response.

74. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
76. Electronic Signature*
77. Date*
    Date
Leave This Blank:


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit

* indicates a required field