CITY OF COVINA WATER UTILITY
FINANCE DEPARTMENT
125 E. College Street, Covina, CA 91723
Phone: 626-384-5230 Email: water@covinaca.gov
Monday – Thursday 7:00am – 5:30pm
Application to Start Water Service
($80 Deposit Required and Copy of I.D. Same Day/Afterhours Connect Fee additional $120)
Today’s Date
: ______________________________
Service Address
: _________________________________________
Account #
: __________________________________ City_________________________ State ____ Zip Code___________
Requested Date for Service
: ____________________
Billing Address
: _______________________________________
Homeowner / Renter / Business (check one) City: ________________________ State ____ Zip Code __________
Name of Applicant/Business (Responsible for bill):
_________________________________________________________
Driver’s License: _______________________________ Telephone: _______________________________
Current Employer: _________________________________________ Work Phone: ______________________________
Work Address: __________________________________________________
City: _______________________________ State: _________ Zip Code: _________________
Email: ______________________________________________________________
Name of Co-Applicant
: __________________________________________________________________________________
Driver’s License: _________________________________ Telephone: ______________________________
Current Employer: __________________________________________ Work Phone: ____________________________
Work Address: ___________________________________________________
City: _________________________________ State: _________ Zip Code: _________________
Email: ______________________________________________________________
Reference:
Name: ________________________________________ Relation: __________________ Telephone: ______________________
To proceed with the service connection, the premises must be ready for service. The City of Covina assumes no liability for
property damage which may occur as a result of uncontrolled water flow beyond the meter due to open valves, plumbing leaks,
fixtures or appliances.
Would you like to proceed with the service connection? Yes ___ No ___
Applicant Signature
: ____________________________________________
Date
: ___________________________
Only authorized city personnel are permitted to turn on service at the meter. Violation may result in fees, fines or
discontinuance of service.
Tampering with meters is a criminal offense; violators will be responsible for all damage, including all parts and labor.
By signing this application customer agrees to be responsible for all water charges and fees, and to comply with all
pertinent city regulations.
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