Water Application and Agreement
The fields marked with an * are required to submit this form.
Application Details
*Application For:
 
*Property Type:
*Service Start Date:  
For property owners, this is the "Title Closing Date"
For renters/lessees, this is the "Lease Start Date"
*Is the water on or off?  
Applicant's Information
*Applicant's Name:  
*Contact Phone Number:  
Cell Phone:
Email:
Renters/Lessees Only
Landlord Name:
Landlord Contact Number:
Has the refundable deposit been paid?
* Only for businesses that are leasing ($100)
Service Address
*Street:   Unit:
*City:   State: UT
*ZIP:  
Billing Address (if different from Service Address)
Street:   Unit:
City:   State:
ZIP:
Comments for Customer Service Representative
Additional Comments:
Applicant Agrees
  • To pay for all water and/or service charges and other fees at the rates set from time to time by the District’s Board of Trustees by the due dates set forth in the District’s water billing statements.
  • To abide by and obey all rules, regulations and policies now and hereafter adopted by the District’s Board of Trustees. A current copy of all such rules, regulations and policies can be obtained from the District on request or on the District’s web page (www.jvwcd.org).
  • To permit the District, its agents and employees to enter the service location at all reasonable times for the purposes necessary to render water service.
  • To make certain that water meters and/or equipment are readily accessible to the District and that no barriers, animals or obstructions prevent access thereto. Applicant hereby authorizes the District, and its agents and employees to take all measures deemed necessary by them to gain access to meters and/or equipment and to use reasonable force in protecting one’s person or property from injury.
  • To pay an interest charge of 1 ½ % per month on any water and/or service charge not paid by the due date.
  • That if the Applicant becomes delinquent for more than 30 days in the payment of charges for water and/or service charges, water services may be discontinued at the discretion of the District until the delinquent bill, interest charges, and a reasonable collection fee have all been paid to the District.
  • That the District has the right to inspect the Applicant’s plumbing for cross connections and hazards.
  • That the District may, without notice, shut off, limit and/or curtail water services due to water and/or delivery, capacity or scarcity, repair or maintain the District’s water system, emergency.
  • To notify the District one week in advance of service termination by applicant.
  • TO PAY ALL COSTS, INCLUDING REASONABLE ATTORNEY’S FEES, INCURRED BY THE DISTRICT THROUGH ITS EFFORTS TO COLLECT ANY DELINQUENT CHARGE OR ACCOUNT AND/OR TO ENFORCE THIS AGREEMENT.
  • The application will be effective upon written acceptance by the District.
  • All parts of the service connection from the downstream side of the meter to the main line are property of the District.
  • The Applicant must protest any bill within 15 days of its postmark; protest is waived if not made timely.
  • THE APPLICANT AND INDIVIDUAL SIGNING FOR THE APPLICANT, AGREE TO BE JOINTLY AND SEVERALLY AND LIABLE FOR GUARANTEE PAYMENT OF ALL WATER CHARGES, COSTS AND OBLIGATIONS AT ANY TIME DUE AND OWING ON THE ACCOUNT.

By submitting this application you are agreeing to the above terms.