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SCMU Application - Inside City Residential

SANTA CRUZ MUNICIPAL UTILITIES (SCMU)

CITY RESIDENTIAL ACCOUNTS

WATER, SEWER, REFUSE SERVICE SIGN-UP

1. SERVICE LOCATION INFORMATION

Service Address - Street, Apt/Ste:*

Service Address - City, State, Zip Code:*
Total number of persons who permanently reside at the above service address:*
(A permanent resident is someone who resides at the service location for at least 21 days within each monthly service period.)
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.*
Requested Service Start Date (No weekends or holidays):*

Requsted Garbage Cart Size:*

2. APPLICANT INFORMATION

First name:*

Last Name:*

Billing Address - Street, Apt/Ste:*

Billing Address - City, State, Zip Code:*

Primary Phone Number:*

Alternate Phone Number:

E-mail Address:

Identification - Document Type:*
Document Number (ID):*

Issued By (State or Country):*

Previous Service Address with SCMU

I DECLARE UNDER PENALTY OF PURJURY 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.

3. OFFICE USE ONLY

Account # --- Meter # --- Location
Deposit Receipt # --- Field Remarks