City Of Youngstown
CITY HALL • 26 S. PHELPS STREET • YOUNGSTOWN, OHIO 44503
PHONE: (330) 742-8746 • FAX: (330) 742-8751
APPLY FOR NEW SERVICE REQUEST
Want to establish service at your new property?
(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.
FOR MOBILE DEVICES, DOWNLOAD ADOBE ACROBAT READER TO FILL OUT AND SEND FORM.
Service Address: ____________________________________
Mailing Address (if different): __________________________
Contact Phone #: ____________________________________
Social Security or EIN #: _______________________________
Service Start Date: ________/________/________
Email Address: _____________________________________
***MUST PROVIDE ONE OF THE FOLLOWING OPTIONS BELOW***
A. IF YOU ARE RENTING THE PROPERTY…we need a copy of your STATE OR GOVERNMENT ID AND A LEASE
AGREEMENT OR NOTARIZED LETTER THAT INCLUDES THE FOLLOWING: Landlord and Tenant Names, Service
Address, Dates of the Lease, and Signatures of all parties.
B. IF YOU ARE PURCHASING THE PROPERTY…we need a copy of your STATE OR GOVERNMENT ID AND A
CLOSING DISCLOSURE, SETTLEMENT STATEMENT OR RECORDED DEED THAT INCLUDES THE FOLLOWING: Your
Name and Address of Property. ***IF YOU ARE A COMPANY PURCHASING THE PROPERTY…IN ADDITION TO
THE ABOVE, YOU MUST INCLUDE THE ARTICLES OF ORGANIZATION FOR THE COMPANY***
C. IF YOU ARE PURCHASING THE PROPERTY VIA LAND CONTRACT…we need a copy of your STATE OR
GOVERNMENT ID AND A LAND CONTRACT DOCUMENT THAT INCLUDES THE FOLLOWING: Buyer and Seller
Names, Address of Property, Dates and Signatures of all Parties.
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