Fill - Free fillable CITY OF YOUNGSTOWN LANDLORDREESTABLISHSERVICEFORMREQUEST (City of Youngstown) PDF form

CITY OF YOUNGSTOWN

WATER DEPARTMENT

CITY HALL • 26 S. PHELPS STREET • YOUNGSTOWN, OHIO 44503

PHONE: (330) 742-8746 • FAX: (330) 742-8751

www.youngstownohio.gov/water

Email: youngstownwater@YoungstownOhio.gov



LANDLORDRE‐ESTABLISHSERVICEFORMREQUEST

IfyouarethepropertyownerofrecordwiththeYoungstownWaterDepartmentandare

requestingthewateraccountbeplacedintoyournametoavoiddisconnectionofserviceorto

haveservicerestoredpleaseCompletethisFormalongwith

A Copy of your STATE OR

GOVERNMENT ID.



(Pleaseallowupto4businessdaystoprocessrequest)

THEYOUNGSTOWNWATERDEPARTMENTRESERVESTHERIGHTTODENYANYREQUESTBASEDONPRIOR

DELINQUENTBALANCESAND/ORINCOMPLETEDOCUMENTATION.

 

Name_______________________________________________

ServiceAddress:_______________________________________

MailingAddress(ifdifferent):____________________________

ContactPhone#:______________________________________

SocialSecurityorEIN#:_________________________________

ServiceStartDate: ________/________/________

EmailAddress: _________________________________________



Byagreeingandsigningbelow,youacknowledgethatTheDivisionofWater,CityofYoungstownisnot

responsibleforanywaterdamagestotheproperty.Ifexcavationisneeded,watermaynotbereconnected

foratleast3businessdaysexcludingweekendsandholidays.ThisispursuanttotheOhioRevisedCode

Section3781.25toSection3781.32.Foranywaterneedingtobeturnedon,thereisanon‐refundableturn

feewhichwillbebilledtoyourwateraccount.

I AGREE ___________________________ ______/_______/______

Customer Signature Date

Ifprintingandmailingthisrequest,pleasefilloutandreturn(ALONGWITHTHEAPPROPRIATEDOCUMENTATION)to:

YoungstownWaterDepartment

26S.PhelpsSt.Youngstown,Ohio44503

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CITY OF YOUNGSTOWN LANDLORDREESTABLISHSERVICEFORMREQUEST (City of Youngstown)

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