APPLE VALLEY FOOTHILL COUNTY WATER DISTRICT

22545 DEL ORO ROAD APPLE VALLEY, CA 92308

Please return this form to the office - 22545 Del Oro Road, Apple Valley, CA 92308; or email to danavfcwd@gmail.com

APPLICATION FOR WATER SERVICE

NAME:                                                                       NAME:                                     

PHONE NUMBER:                                                     PHONE NUMBER:                             

CONTACT EMAIL:                                                     CONTACT EMAIL:                             

PHYSICAL ADDRESS:                                                                   

MAILING ADDRESS (IF DIFFERENT THAN PHYSICAL):                                                                              START DATE: PARCEL NUMBER:                                       

DEPOSIT REQUIRED: $204.26

THE WATER SUPPLIED BY APPLE VALLEY FOOTHILL COUNTY WATER DISTRICT IS TREATED. THE PRESSURE PER SQUARE INCH RANGES FROM APPROXIMATELY 30-80 PSI; A WATER PRESSURE REGULATOR VALVE SHOULD BE INSTALLED AT THE WATER METER DIRECTLY AFTER THE CUSTOMER WATER METER SHUT-OFF VALVE.

THE DISTRICT SHALL NOT BE LIABLE FOR DAMAGE THAT MAY RESULT FROM INTERRUPTION IN SERVICE FROM A CAUSE BEYOND THE CONTROL OF THE WATER DEPARTMENT. THE DISTRICT WILL NOT BE LIABLE FOR INTERRUPTION, SHORTAGE, OR INSUFFICIENCY OF SUPPLY OR FOR ANY LOSS OR DAMAGE OCCASIONED THEREBY IF CAUSED BY ACCIDENT, ACT OF GOD, STRIKE, RIOT, PROTEST, WAR, OR ANY OTHER CAUSE NOT WITHIN ITS CONTROL.

BY SIGNING THIS APPLICATION, THE APPLICANT AGREES TO OBSERVE ANY DISTRICT RULES, REGULATIONS, AND ORDINANCES NOW OR HEREAFTER ADOPTED RELATED TO THE WATER SERVICE AND TO PAY WATER BILLS PROMPTLY.

I HAVE READ AND UNDERSTOOD THE ABOVE AND ALSO UNDERSTAND I AM RESPONSIBLE FOR PAYING THE WATER BILL UNTIL I ORDER SERVICE DISCONTINUED.

SIGNATURE:                                             DATE:                             DRIVERS LICENSE:                                     DOB:                     

RETURN THIS FORM AND DEPOSIT WITHIN 10 DAYS TO AVOID INTERRUPTION IN SERVICE