Please correct the field(s) marked in red below:

Multi-Family Residential - Outside City

Application for Water Services ONLY

SERVICE LOCATION INFORMATION

Service Address - Street, Apt/Ste
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Service Address - City, State, Zip Code
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Total number of persons who permanently reside at the above service address

(A permanent resident is someone who resides at the service address for at least 21 days within each monthly service period.)

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I declare, under penalty of perjury, that the above information is true and correct. I understand that I am responsible for notifying the City of Santa Cruz Water Department within 10 days if the number of persons who permanently reside at the residence changes. I understand that false information will result in Excess Use Penalties for any water used over the standard allotment, and could result in discontinuation of water service and/or full prosecution as allowed under the laws of the State of California.
I have read, understand, and agree with the above declaration.
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Requested Service Start Date (no weekends or holidays):
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APPLICANT INFORMATION

First Name:

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Last Name:

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Billing Address - Street, Apt/Ste
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Billing Address - City, State, Zip Code
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Primary Phone:
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Alternate Phone:
E-mail:
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ID - Document type
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ID - Document Number
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ID - Issued by (State or Country)

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Previous Service Address with SCMU
I DECLARE UNDER PENALTY OF PERJURY THAT 1) I AM THE RESPONSIBLE PARTY AT THE SERVICE ADDRESS AND/OR AN AUTHORIZED REPRESENTATIVE OF THE BUSINESS, AND 2) THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT. I ACCEPT RESPONSIBILITY FOR THIS UTILITY SERVICE AND AGREE TO ABIDE BY ALL RULES AND REGULATIONS ESTABLISHED BY THE CITY COUNCIL GOVERNING UTILITIES.
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