Residential (Less than 5 parcels) - Water Service Information Request

PLEASE PROVIDE THE FOLLOWING PRELIMINARY INFORMATION FOR ARIZONA WATER COMPANY TO REVIEW YOUR REQUEST:

Address of property to be served

County

Tax Assessor Parcel Number(s)

Major Cross Streets

Street Address

City

State

Zip Code

Requestor Name/Mailing Address

(if different from property address)

First Name

Last Name

Email Address

Phone

Confirm Email Address (must match email above)

Street Address

City

State

Zip Code

Applicant/Owner - Mailing Address

Same as Requestor

(if different from property address)

First Name

Last Name

Email Address

Phone

Confirm Email Address (must match email above)

Street Address

City

State

Zip Code

Will this property be split into 2 or more parcels?

Yes No

Provide the following documents: assessor map, property deed, easements, and record of survey
File Format:JPG,PDF File Size: If file exceeds 12MB, email documents to developmentservices@azwater.com

Hold CTRL (PC)/ CMD (MAC) to select multiple files. Multiple files must be selected at the same time.

Intended Property Use

Single Family Residential Other

If other please describe

Fixtures:

List the total number of each fixture
enter "0" if not applicable.

Toilet(s)

Bathroom Sink(s)

Bath Tub(s) w/Shower

Stand Alone Shower(s)

Laundry Room Sink(s)

Hose Connection(s)

KitchenSink(s)

Dishwasher(s)

Garbage Disposal(s)

Washing Machine(s)

Other Fixtures(s)

Type of Service

New Service Existing Service

Meter Size

Total Fixture Supply Units:

Based on fixtures entered above.

Meter Quantity

If Temporary, Describe Purpose

*Service to non-primary residence, ex: landscape, barn, guest house, tool shop, etc.

Scope of Work

If Upsize/Downsizing an existing service and meter

Existing Meter Size

Requested Meter Size Change

List Any Additional Information Regarding the Property to be Served

200 words remaining

Note: The determination of the method of service and the preliminary cost estimate to serve this property are based on the information you provide. If the property is split in a manner different than that indicated on the Water Service Information Request form, the method of service and preliminary cost estimate may need to be revised. Water service to your property may require easements, a main extension agreement, a conditional water service agreement, a temporary service agreement and backflow prevention devices. By signing below you certify to the best of your knowledge that the information provided by you is true and accurate.

Disclaimer: The method of service determinations and preliminary cost estimates are preliminary in nature and may not represent actual costs of method of service. Please be advised that the actual cost of establishing service to your property can only be determined upon receiving an application for service, payment of all required deposits and fees and receipt of bids from contractors.

I acknowledge I have read the above note and disclaimer

Printed Name (typing your name acts as your digital signature)

Date Signed

Confirm Printed Name (must match above)

Response time:
Please allow up to 45 business days to complete the Water Service Information Request prior to contacting the Company.

Submitting Your Residential (Less than 5 parcels) - Water Service Information Request

Things You Need To Know:

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