Start or Stop Service

Start Service

Requests to start service received after 2:30 p.m. Monday-Friday will be processed the next business day. Requests received on holidays or weekends will be processed the next business day.

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Instructions

For Owners:

Submit this form with proof of ownership and a copy of your ID. Send in a $40 nonrefundable new account fee via mail or at the District’s drop box. The name on the ID, proof of ownership, and this application must match.

For Tenants:

Submit this form with a copy of your ID. Send in a $40 nonrefundable new account fee and a $100 deposit via mail or at the District’s drop box. The name on the ID and this application must match.

Payments must be made in cash or check and received at our office within 10 days to avoid shutting off.

You will need to provide a copy of:

Driver’s License (ID)

And if an owner, one of the following:

Recorded Deed
Final Escrow Statement
Homeowner’s Insurance Policy
Property Tax Bill

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Start Service

Applicant Information

First Name(Required)

Last Name(Required)

Rent or Own?(Required)

Number of Occupants(Required)

Please enter a number from 1 to 99.

Service Start Date(Required)

Service Address(Required)

Street Address

Driver's License(Required)

Driver's License State(Required)

Mailing Address

Address

Street Address City State ZIP Code

Contact Information

Phone(Required)

Cell Phone

Email(Required)

Enter Email Confirm Email

Applicant Employment Information

Employer(Required)

Employer Telephone

Friend or Relative (not living with you)

Name(Required)

Phone(Required)

Landlord Contact Information (if renting or leasing, please complete this section)

Name

Phone

Landlord Address

Upload ID(Required)

Max. file size: 4 GB.

Upload Proof of Ownership

Max. file size: 4 GB.

Declaration and Signature

The undersigned hereby applies for Domestic Water and/or Wastewater Service on the today’s date at which time service will be furnished at regular rates and may be discontinued upon notification by applicant. It is agreed that Crescenta Valley Water District shall not be responsible for damage to person or property caused by failure of defects of pipes, high or low pressure, by escape or leakage due to conditions on said premises at or after turning service on, failure or lack of backflow devices or pressure regulators and applicant will hold Crescenta Valley Water District harmless therefrom. Customer agrees to comply with the Rules and Regulations of District, as amended from time to time. Customer acknowledges responsibility for installation of an approved backflow prevention device and/or backwater check valve, where necessary. The Rules and Regulations are available for review at the District office. Customer acknowledges receipt of direction to the district’s website for the most recent annual water quality analysis. Customer acknowledges that District has informed Customer that District’s water may react with water pipes, valves, connections, pumps and other water system facilities (Facilities) on Customer’s Property identified above, and may cause damage to the Facilities such as pitting’s, hardness buildup, rusting, or any other type of corrosion. Customer hereby waives all claims against District, and it directors, officers, agents, contractors and employees, that Customer now has, or may have in the future, related to any injury or damage of any type to the Facilities, or other improvements on customer’s Property, caused by any chemical reaction involving the water supplied by District.

Signature (type full name)(Required)

Date(Required)

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Stop Service

Requests to stop service receive before 2:30 p.m. Monday-Friday will be processed the next business day. The soonest date to stop service is the next business day.

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Stop Service

Service Information

Date you want to stop service(Required)

Account Number (if known)

Service Address(Required)

Street Address

Applicant Information

Pick what best describes you(Required)

Property Owner

Tent Renting or Leasing

Property Manager of Realtor

Name(Required)

First Name Last Name

If you are the property owner, has the property been sold?

Yes

Service Address(Required)

Street Address City ZIP Code

Forwarding Address for Final Bill

Name(Required)

First Name Last Name

Forwarding Address(Required)

Street Address City State ZIP Code

Home Phone(Required)

Mobile Phone

Work Phone

Email(Required)

Confirm Email(Required)

Signature and Acknowledgement

I hereby certify that I am the customer of record for the service address listed above and I am authorizing the District to stop water service on the requested date above

Applicant Signature(Required)

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