City Of Pasadena, Texas
Residential Services Application
Please note that applications will not be processed without the following:
Photo identification, SSN and a deposit (Owner - $125, Renter - $150).
First and last pages of either the settlement statement or lease agreement
All names on ownership or lease documents will be listed on the account. Please note that the account will be billed
as of the date on the aforementioned documents and may be subject to back bill charges.
Additional deposits are required if there is a separate meter for irrigation (sprinkler) purposes (based on size of meter).
If there is a swimming pool at the service address, an additional $25 deposit is also required.
NOTE: We reserve the right to hold or delay service requests if service location was recently disconnected for non-
Connect Date: _________________________ Service Address: _____________________________________________________________________
Applicant Name: ________________________________________________________ Driver’s License or ID#_____________________________
Date of Birth: _________________ Is applicant 65 or Older? Yes No If yes, applicant qualifies for discounted rates.
SSN: ______________________________ Contact#: ______________________________ Alternate Contact#: ___________________________
Email Address: ______________________________________________________________
Mailing Address (if different from Service Address): ________________________________________________________________________________
Spouse/Other Occupant Name: __________________________________________ DL or ID#______________________ DOB: ___________________
Spouse/Other Occupant SSN: _____________________________________________ Contact#: _____________________________
Owner Name (if renting): ____________________________________________________ Owner Phone# ________________________________
Account Confidentiality Request: Section 182.052 of the Texas Utilities Code provides that a government-operated utility such as the City of
Pasadena may not disclose personal information in a customer’s utility account or other information related to utility usage or billing if the
customer requests that the information be kept confidential. The Texas Utilities Code also allows the utility to access a fee for this request.
Please choose one of the following:
_____ Yes, I request confidentiality. I understand there is a $2 one-time fee. _____ No, I do not request confidentiality.
I (we) hereby apply for services at the above address. I (we) understand that there is a $30.00 non-refundable connect fee
to cover maintenance and administrative costs related to opening an account. I (we) understand that the bill is due and
payable 18 days from the billing date. Failure to receive a bill does not waive penalty nor does it extend the due date. In
addition, I (we) am aware that I (we) don't need to be home to connect service, but if there is a leak, open pipe or open
faucet (dial on meter is moving), the technician will turn the water off at the meter. If I (we) request for City staff to return to
the premises to turn the water on, there will be a $20.00 return trip fee.
In addition, I/we understand that the City of Pasadena verifies the personal information provided on this application using
various databases. If the City determines that I or other people shown as owners or listed on a lease owe past due
balances to the City, I/we will be responsible for payment of those balances or can be transferred to this account.
Signature: __________________________________________________________ Date: _______________________________________
Co-Occupant Signature: ____________________________________________ Date: _______________________________________
IMPORTANT - Please note that your water and sewer bills are based on the amount of water you use. Every customer has a
water meter that separates the city's water system from his/her private plumbing system. Once the water passes through the
meter, the customer has purchased it and it no longer belongs to the city.
Notice: Per City Ordinance #2008-107, the City charges a water and sewer meter size base fee for all meters larger than the
standard 5/8th.
1202 Southmore Ave 77502 · PO Box 1337 · Pasadena, TX 77501-1337 · Phone (713) 475-5566 ·
For Office Use Only:
CSR Initials/#: _______________ Same Day Connect? Y N Account#: ___________________________________
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City of Pasadena & El Cary Estates Service Agreement
I. PURPOSE. The City of Pasadena is responsible for protecting the drinking water supply from contamination or pollution which could
result from improper system construction or configuration on the retail connection owner's side of the meter. The purpose of this service
agreement is to notify each customer of the restrictions which are in place to provide this protection. The public water system enforces
these restrictions to ensure the public health and welfare. Each retail customer must sign this agreement before the City of Pasadena will
begin service.
II. RESTRICTIONS. The following unacceptable practices are prohibited by State regulations.
A. No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of
contamination shall be isolated from the public water system by an air-gap or an appropriate backflow prevention device.
B. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the
public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone
backflow prevention device.
C. No connection which allows water to be returned to the public drinking water supply is permitted.
D. No pipe or pipe fitting which contains more than 0.25% lead may be used for the installation or repair of plumbing at any connection
which provides water for human use.
E. No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which
provides water for human use.
III. SERVICE AGREEMENT. The following are the terms of the service agreement between the City of Pasadena and the Customer.
A. The Customer shall allow his property to be inspected for possible cross-connections and other potential contamination hazards. These
inspections shall be conducted by the City of Pasadena or its designated agent prior to initiating new water service; when there is reason
to believe that cross-connections or other potential contamination hazards exist; or after any major changes to the private water
distribution facilities. The inspections shall be conducted during the City of Pasadena’s normal business hours.
B. The City of Pasadena shall notify the Customer in writing of any cross-connection or other potential contamination hazard which has
been identified during the initial inspection or the periodic re-inspection.
C. The Customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards
on his premises.
D. The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the City of Pasadena.
Copies of all testing and maintenance records shall be provided to the City of Pasadena.
IV. ENFORCEMENT. If the Customer fails to comply with the terms of the Service Agreement, the City of Pasadena shall, at its option, either
terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any
expenses associated with the enforcement of this agreement shall be billed to the Customer.
Your Role as a Water Customer
By taking steps to control cross connections and prevent the possibility of backflow at your home, you will help to protect the
public water supply and ensure that your family continues to enjoy safe drinking water.
Hose bibb vacuum breakers must be installed on each of your outside faucets. The hose bibbs must be installed before the service
technician arrives at the service address. If the technician does not see them, water service will not be connected. You will be then
be required to contact the office once they have been installed to have water service connected and a $20 trip fee will be assessed.
Customer’s Signature:_________________________________________________ Date:__________________________
These inexpensive devices are designed to allow water
to flow in only one direction. You can find them at most
home supply stores and through plumbing suppliers.
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