Residential Water Service Application
Address of New Water Service:___________________________________________
Date Water Should Be Turned On:_________________
Are you the Renter or Owner: œ Renter œ Owner
Owners Name:_________________________________________________
Name:_______________________________________________________
Soc Sec #:_______________________________________
Name of Spouse:______________________________________________
Soc Sec #:_______________________________________
Mailing Address (PO Box)____________________________________
Home Phone:________________________Work Phone:______________________
Employer:____________________________________________________
Spouse Employer:_________________________________
Previous Address:___________________________________________
Roommates:__________________________________________________________
There is a combined utility deposit required of $130.00 for all rental properties.
We consider applicants without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
If you are moving out of your apartment or house, you must contact City Hall in order to get the water out of your name. You will also need to let us know your forwarding address. You may contact us at 732-8020 or stop by City Hall located at 620 Erie Street. Thank you!
THE UNDERSIGNED HEREBY AGREES TO COMPLY WITH THE RULES AND REGULATIONS OF THE CITY OF STORM LAKE.
Signature_______________________________
Spouse’s Signature _______________________
Date_____________________