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Request For:
Date:
Name:
Address:
City:
State:
Zip:
Home Phone:
Emergency Contact Phone:
Property Affected:
Address of Property:
Account to be issued in name of:
Date requested service to be instituted:
Will you be residing at the residence as owner or leasing out the residence?


By clicking the button below you are stating that you have read, understand and agree to the following:

Lockwood Water & Sewer District Rules and Regulations are available on this website for review and future reference.

APPLICANT'S CERTIFICATION: By acknowledging this request, applicant, under penalty of law, represents that he/she is eighteen (18) years or older, of sound mind and legally owner of the real property described herein, and, if acting on behalf of a corporation, partnership or other non human entity, that he/she is duly authorized to enter into this agreement on behalf of such entity.

IDEMNIFICATION: Applicant agrees to protect and hold harmless the District from any and all liability, loss, costs or expense, including attorney's fees on account of or in any way resulting from suits, claims, or actions for damages to any person arising out of or resulting from any false statement, representation or certification contained herein.

NOTICE: WATER SERVICE WILL BE SHUT OFF AT THE TIME OF FINAL READING AND WILL REMAIN OFF UNTIL ALL OUTSTANDING BILLS AGAINST THE PROPERTY ARE PAID IN FULL.

 

 

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