Pine Grove Community Services District - APPLICATION FOR WATER SERVICE

LOCAL HOME/BUSINESS INFORMATION:

RESPONSIBLE PARTY'S CONTACT INFORMATION

Enter the relationship with the property owner. If you are the property owner, enter "Self".

ALTERNATE CONTACT INFO

Enter the relationship with the property owner. If you are the property owner, enter "Self".

Is this property a rental? If so please provide renter's name and phone number.

Pet Information

I agree to the terms and conditions of the Rules and Regulations of the Pine Grove Community Water Services District. A copy of the Rules and Regulations are available at your request. Please note that payments for rentals are the responsibility of the owner of the property. If you are selling your property or have a renter moving, please contact us in advance for a final meter read and final billing. Your submission of this form is considered your signature of this document.
Water Company Use: Meter Connection # _________ APN:____________ Billing Acct# ___________ Date Received:__________________