Residential Service Application

HERNANDO COUNTY UTILITIES

RESIDENTIAL SERVICE

Water Only

Applicant	Deposit	Service Charge	Total
Owner	$60	$100	$160
Tenant	$100	$100	$200

Water/Sewer

Applicant	Deposit	Service Charge	Total
Owner	$235	$100	$335
Tenant	$375	$100	$475

Irrigation

Applicant	Deposit	Service Charge	Total
Owner	$60	$100	$160
Tenant	$100	$100	$200

*Irrigation is included if turned on at the same time as water/sewer

The undersigned applicant(s) for water/sewer service agree(s), jointly and severally, if applicable, to conform to and abide by all the rates, rules and regulations provided by ordinance, code, resolution or otherwise of the Hernando County Water and Sewer District for water and/ or wastewater service as are now or hereafter in force and which are a part of this contract. Applicant(s) further agree(s), jointly and severally if applicable, to pay water and wastewater hookup and connection fees where applicable amd to pay all charges for water and/or wastewater service, as they may become due and at the scheduled rate in effect, unless and until notice in writing is given by the applicant(s) to the District through the Utilities Department that service is to be discontinued for whatever period of time. Connection fees paid to the Utilities Department are non-refundable by ordinance.

Have you had service with Hernando County Utilities in your name?
If so, please provide service address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
APPLICANT - FULL NAME (if Business type N/A)

First NameMiddle NameLast Name
APPLICANT- Business Name (if not a business type N/A)
APPLICANT - EMAIL
example@example.com
APPLICANT - PHONE NUMBER

Area CodePhone Number
APPLICANT - LAST 4 DIGITS OF SOCIAL SECURITY or EIN
APPLICANT - PLEASE UPLOAD ONE OF THE FOLLOWING: DRIVERS LICENSE, PASSPORT, OR IDENTIFICATION CARD (SELFIES ARE NOT AN ACCEPTABLE FORM OF IDENTIFICATION).

Browse Files
Allowed Types: gif, jpg, jpeg, png, doc, docx, xls, xlsx, rtf, pdf Cancelof
APPLICANT - MAILING ADDRESS (Invoices are sent to this address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CO-APPLICANT - FULL NAME

First NameMiddle NameLast Name
CO-APPLICANT - PHONE NUMBER

Area CodePhone Number
CO-APPLICANT - LAST 4 DIGITS OF SOCIAL SECURITY
CO-APPLICANT - PLEASE UPLOAD ONE OF THE FOLLOWING: DRIVERS LICENSE, PASSPORT, OR IDENTIFICATION CARD (SELFIES ARE NOT AN ACCEPTABLE FORM OF IDENTIFICATION).

Browse Files
Allowed Types: gif, jpg, jpeg, png, doc, docx, xls, xlsx, rtf, pdf Cancelof
DO YOU CURRENTLY HAVE WATER SERVICE WITH HERNANDO COUNTY?
CURRENT SERVICE LOCATION:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ARE YOU DISCONNECTING WATER SERVICE AT THIS LOCATION?
IF YES, WHAT DATE ARE YOU DISCONNECTING SERVICE?

MonthDayYear
Date
WHO IS COMPLETING THIS APPLICATION?

OWNERSHIP: HAVE YOU OWNED THE PROPERTY WHERE YOU ARE STARTING SERVICE FOR MORE THAN SIX (6) MONTHS?

DO YOU CURRENTLY HAVE "PROOF OF OWNERSHIP" DOCUMENTS TO UPLOAD?
FOR OWNERS, VERIFIABLE PROOF OF OWNERSHIP IS REQUIRED. PLEASE UPLOAD YOUR DOCUMENTATION.

Browse Files
Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt Cancelof
IF APPLICABLE:
- TITLE COMPANY
- TITLE COMPANY PHONE NUMBER
- ESCROW/FILE NUMBER
- CLOSIING DATE
TITLE COMPANY
TITLE COMPANY PHONE NUMBER

Area CodePhone Number
ESCROW/FILE NUMBER
CLOSING DATE

MonthDayYear
Date

TENANTS, THE FOLLOWING DOCUMENTATION IS REQUIRED:
- Lease Terms and Signature Page or Notarized Letter of Authorization
- Valid Government-issued photo ID
- Deposit and Service Charge
UPLOAD YOUR LEASE OR LETTER OF AUTHORIZATION

Browse Files
Allowed types: .gif, .jpg, jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt Cancelof
ANY ADDITIONAL DOCUMENTATION (OPTIONAL)

Browse Files
Allowed types: .gif, .jpg, jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt Cancelof

AGENT/PROPERTY MANAGERS, THE FOLLOWING DOCUMENTATION IS REQUIRED:
- Property Management Agreement
- Valid Government-issued photo ID
- Deposit and Service Charge
UPLOAD YOUR PROPERTY MANAGEMENT AGREEMENT

Browse Files
Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt Cancelof
ANY ADDITIONAL DOCUMENTATION (OPTIONAL)

Browse Files
Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt Cancelof

SERVICE ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parcel Key #:
PLEASE ENTER THE DATE THE SERVICE NEEDS TO BE TURNED ON:

MonthDayYear
Excluding Weekends and Holidays

CONTRACT AND WAIVER (MUST ACKNOWLEDGE/CHECK ALL)
PUBLIC RECORDS EXEMPTION (ALTERNATIVE)
REASON FOR EXEMPTION
Please type in your first and last name below to signify you agree that the information you have provided is correct to the best of your knowledge.
APPLICANT - SIGNATURE

Clear
CO-APPLICANT - SIGNATURE

Clear
APPLICATION'S SIGNATURE
CO-APPLICANT'S SIGNATURE
Should be Empty:

HERNANDO COUNTY UTILITIES

Water Only

Water/Sewer

Irrigation