APPLICATION FOR WATER SERVICE
[ ] Primary Residence or Second Home (Owner Occupied) [ ] Rental (Tenant) [ ] Vacation Rental
Commercial Industrial Institution
SERVICE ADDRESS: _____________________________SERVICE AS OF: _____________
**PLEASE NOTE - In most instances, Joshua Basin Water District does not require a rental or lease agreement to start service.
A copy of the Closing Disclosure is required for change of ownership.
If you are moving and need to disconnect service or you want to change your mailing address,
please visit www.jbwd.com for the required forms.
Important, please read: I, the undersigned, have completed this application and affirm/swear the information is correct. I agree to comply with
all District Ordinances, Policies, Rules, and Regulations now in force, or which may hereinafter be put in force.
By signing, I acknowledge that I have read and understand the terms of service, shown on the reverse.
____________________________________________________ _______________________________________________________
CUSTOMER’S SIGNATURE DATE CUSTOMER’S SIGNATURE DATE
Joshua Basin Water District is a recipient of federal funds from the US Department of Agriculture, and they request the following information to show the extent to
which members of minority groups are beneficiaries of federally funded programs. Participation is voluntary.
ETHNICITY: Hispanic or Latino Not Hispanic or Latino RACE: American Indian or Alaska Native Black or African American □ Asian White
SEE REVERSE FOR IMPORTANT INFORMATION REGARDING RULES AND POLICIES
DISTRICT USE ONLY
[ ] VERIFIED IDENTIFICATION DEPOSIT________________
[ ] DEPOSIT WAIVED/ACCT#____________________________________ [ ] APPLIED____________________ ASF________________
REINSTALL FEE________________
RECEIPT #_____________________ ZONE__________________ JOB#_____________________ CAPACITY CHARGE________________
(IF APPLICABLE) SEWER CAPACITY CHARGE ________________
METER INSTALLATION FEE________________
TOTAL FEES PAID $________________
CUSTOMER INFORMATION: CUSTOMER INFORMATION:
NAME________________________________________________ NAME_________________________________________________
DRIVER’S LICENSE NUMBER____________________________ DRIVER’S LICENSE NUMBER______________________________
EXPIRATION DATE__________________ STATE____________ EXPIRATION DATE__________________ STATE______________
DATE OF BIRTH_______________________ DATE OF BIRTH______________________
SOCIAL SECURITY NUMBER_____________________________ SOCIAL SECURITY NUMBER______________________________
TAX ID NUMBER (FOR BUSINESSES) _____________________ TAX ID NUMBER (FOR BUSINESSES) _______________________
PHONE NUMBER_______________________________________ PHONE NUMBER_______________________________________
EMAIL________________________________________________ EMAIL________________________________________________
MAILING ADDRESS (IF DIFFERENT FROM SERVICE ADDRESS) _______________________________________________________
_____________________________________________________________________________________________________________
I CERTIFY THAT I: OWN RENT MANAGE SAID PROPERTY CHANGE OF OWNERSHIP DATE ________________
Payment must be made within 48
hours of application. If payment
has not been received, the
account will be cancelled and all
paperwork must be resubmitted.
DISTRICT USE ONLY
Account #______________
APN # ______________
click to sign
signature
click to edit
click to sign
signature
click to edit
BUSINESS HOURS: Monday - Friday 8:00 a.m. to 5:00 p.m.
BOARD MEETINGS
Held regularly on the first and third Wednesdays of each month at 6:30 p.m.
REQUIREMENTS TO START SERVICE
To start water service, a valid government issued picture identification must
be submitted along with the completed application, and all fees including a
deposit (if required) must be paid.
DEPOSIT QUALIFICATIONS
The credit score is obtained through the social security number. If
an SSN is not provided; the customer will be considered to have the lowest
category of credit. An applicant with good credit will not be required to pay a
deposit. If the applicant does not provide a social security number or has poor
credit, they may be required to pay up
to a double deposit.
GUARANTEE DEPOSIT
After establishing a satisfactory payment record, the District will
refund the guarantee deposit by crediting the customer’s account. If service is
discontinued before 24 months, the deposit will be applied
to the closing bill, and a refund checks her the balance or a water bill will be
mailed to the customer at his/her last known address.
BILL PAYMENT
Bills for water service are rendered at the end of each month. Payment is due
upon receipt and is late 21 days after the date of billing. An outside drop box
is available to make a payment at any time. Customer’s water service will be
turned off after written notice from the District if payment is not made within
35 days of the billing date.
PAYMENT OPTIONS
The District accepts cash, check, or money order.
If you wish to pay by credit card or echeck, please visit paymentus.com
The District also offers Autopay, a convenient automatic payment option that
allows the customer to pay their monthly water bill directly from their
checking or savings account.
DELINQUENT ACCOUNT SERVICE CHARGE
Accounts not paid by the delinquent date will be charged a one-time 10%
delinquent account service charge plus a 1-1/2% per month service charge on
the unpaid balance.
FAILURE TO RECEIVE BILLINGS
The customer is still responsible for payment of water bill whether or not a
bill has been received and should notify the District if a bill has not been
received.
TURN-OFF FOR NON-PAYMENT
Water meters will be turned off for non-payment on or after the 35
th
day after
the original date of the billing for service. When the District is required to
written notice in regards to disconnection of water service, the account holder
will be charged a fee for this service. Water service turned off for non-
payment will not be turned on again until the total account balance, unlock
fees, and the double guarantee deposit (if applicable), has been paid in full.
DISTRICT OWNERSHIP OF WATER SYSTEM
FACILITIES
All customer service facilities, including the meter, are the property
of the District, and will be operated and maintained by a District
Representative only.
LOCKED METERS
Meters that are locked by the District shall not be unlocked except
by a District Representative. If a customer tampers with District property,
charges for material, labor, and water bill will be adjusted
to include the damage and usage plus a deposit of 2 1/2 times the standard
deposit will be required.
METER ACCURACY
All meters are tested before installation. No meter is installed that shows a
variance greater than 1.5% plus or minus. Any customer
has the right to have his/her meter tested upon completion of an
application and payment of the test fee. If the meter has stopped recording
usage or the meter has been removed by someone other than a District
representative, the District will estimate the usage
and apply an adjustment to the customer’s next billing.
CUSTOMER VACATING PREMISES
Customers desiring to have service discontinued should notify the District in
writing prior to vacating the premises. Unless turn-off of service is so ordered,
the customer is liable for any continued water usage.
COLLECTION OF ACCOUNTS
The District will attempt to collect all unpaid water charges including
penalties and interest by letter contact. The District retains the right
to use this and all other means of collecting unpaid accounts.
CUSTOMER COMPLAINTS
Customers are welcome to contact the District office during regular business
hours. The appropriate staff will make every reasonable attempt to come to an
understanding with the customer. Should a customer be unable to reach
satisfaction with his/her question, he/she may submit his/her question or
complaint in writing to Management for consideration. The customer may
appear before the Board after requesting to be included in the agenda.
DESCRIPTION OF CHARGES
Water:
The consumption charge for actual water use,
which funds a portion of the District’s operational
expenses including power for pumping, lab fees
for water testing and pump & well maintenance.
Basic Fee:
The charge for water service, including no water
usage, which funds a portion of the District’s
operational expenses including meter reading, leak
repair, and liability insurance.
WATER USE QUESTIONNAIRE
Date:
APN:
Phone
Number:
Meter Number:
New Service:
Yes
No
Existing Service: Yes
No
*By
signing this document,
I
am certifying that the
statements
below are true.
I
also understand that
if
at any
time
JBWD
staff discovers that these
statements
are incorrect and that
I
pose a health hazard, it may result in
my
water service being turned off.
Name____________________________________ Date________
RESIDENTIAL-
CHECK ALL THAT
APPLY
Grey water reclamation system.
Fire service (service for a fire hydrant or building sprinkler
system).
Booster pump (pump to increase the water
pressure)
.
Domestic
well
(well water used for consumption).
Irrigation system for landscaping or dedicated
water
meter for that
purpose.
Multi-service
connection (more than one water service to
the
property).
Buildin
g
or equipment is
20
feet above the service connection.
Swimming
pool
or
spa.
Home based
business:_____________________________
Solar
water heater system.
None of the above
COMMERCIAL CHECK ALL THAT APPLY
Buildin
g
over three (3) stories in
height.
Treated Water (chemicals added to water for
heating,
cooling
or
irrigation).
Irrigation system for landscaping or dedicated water meter for
that
purpose.
Chemical
processing or repackaging
(operation
using
chemicals).
Cold Storage (freezer room or cooler).
Irrigation/Domestic Well
(well
used to water plants,
crops or
consumption).
Medical
office or
Medical
treatment.
Drink dispenser using a carbonator (soft drinks not in cans or
bottles)
.
Steam generating (steam boiler, autoclave or steam producing
equipment).
Recycled water (equipment using the same water more than
once).
Reclaimed water (treated water from the sewage treatment
plant).
Waste
interceptor (grease receptor/trap,
etc.).
Water for decorative use (a
pool,
fountain,
stream,
etc.).
Water
make-up (replacement water to equipment due to
evaporation or
use).
Water pumping other than a hot water
re-circulation.
Water-cooled
equipment (water circulated through water
equipment jackets)
.
Gre
y
water reclamation system
.
Fire
service (service for fire hydrant or building sprinkler
system).
Booster pump (pump to increase the water
pressure)
.
Multi-service connection (more than one water service to the
property).
Building or equipment is
20
feet above the service
connection.
Swimming
pool
or spa.
Solar
water heater system
None
of the
above
FOR
OFFICIA
L
USE ONLY
DEGREE
OF
HAZARD
No Hazard at this time.
Non-Health Hazard (Pollution)
Health Hazard (Contamination)
Description of Hazard________________________________________________________
___________________________________________________________________________
Sewage
TYPE OF DEVICE REQUIRED
Air Gap
Double Detector Check (DCDA)
Reduced Pressure Principal Detector Assembly (RPDA)
Double Check (DC)
Reduced Pressure Principal Assembly (RP)
None
SUBMIT FORM
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome