Please enable JavaScript in your browser to complete this form.Pine Grove Community Services District - APPLICATION FOR WATER SERVICEDate / Time *LOCAL HOME/BUSINESS INFORMATION:Property Owner's Name *FirstLastResident's Name *FirstLastStreet AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBillilng AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *RESPONSIBLE PARTY'S CONTACT INFORMATIONName *FirstLastRelationship to Property OwnerEnter the relationship with the property owner. If you are the property owner, enter "Self". Home PhoneWork PhoneCell PhoneALTERNATE CONTACT INFOName *FirstLastRelationship to Property OwnerEnter the relationship with the property owner. If you are the property owner, enter "Self". Home PhoneWork PhoneCell PhoneIs this property a rental? If so please provide renter's name and phone number.Renter's Name *FirstLastRenter's Best Contact PhonePet InformationThe District Water Manager may need to enter your property to read the metere. Do you have a pet he/she should be aware of? *YesNoIf YES, what type and how many?Is there a well or secondary water source on the property?YesNoI 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. I understand that my signature below acknowledges my responsibility for all payments and charges applicable to the applied service(s) in accordance with the Pine Grove community Service District Rules and Regulations. Please note – payment for rentals are the responsibility of the Owner.E-Signature *FirstLastPlease type your full name to accept the terms.Water Company Use: Meter Connection # _________ APN:____________ Billing Acct# ___________ Date Received:__________________NameSubmit