Date of Application (mm/dd/yyyy) (required)
Service Location (Address, Lot, Block, Tract #, Etc.. (required)
Temporary Service? (required) Select One
No
Yes
If Temporary, what is the expected duration
Applicant Name (required)
Phone Number (required)
Email Address (required)
Applicant Street Address (required)
Applicant City, State Zip (required)
Owner Name (If Different)
Owner Phone (If Different)
Owner Email (If Different)
Construction Start Date (required)
Requested Service Operational Date (required)
Water Service Type (e.g., Residential, Commercial, Irrigation, Duplex, Apartment, etc.) (required)
Parcel Size (acres) (required)
Primary Building Seize (sq. ft.) (required)
Second Building? Select One
No
Yes
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