City of Sweet Home
Residential Water/Sewer Account Application
Today’s Date:
Date Service Needed:
Are you a new resident to the City of Sweet Home? Yes No
Primary Applicant: (PLEASE PRINT) Rent Own
Name:
Date of Birth:
Driver’s License or State ID #:
Email:
Service Address:
Phone #:
Mailing Address:
City
State
Zip
Co- Applicant: (MUST BE PRESENT)
Name:
Date of Birth:
Driver’s License or State ID #:
Email:
Phone #:
Property Owner:
Name:
Phone #:
Mailing Address:
City
State
Zip
A deposit of $150.00 is required BEFORE service is turned on. This deposit will be applied to the closing bill and any
remaining credit will be refunded. If the customer moves to a new City service the deposit may be transferred provided
there are no past due amounts owed and the current account is scheduled to be closed within 3 days. All customer
accounts must be in good standing before any deposit is refunded.
Accounts are due when mailed and payable by the 15
th
of the month. If the account is not paid in full by the 15
th
, it is “past
due” and considered to be delinquent. Service disconnect/delinquency notices are mailed to those accounts which are
“past due” and a copy sent to the property owner, if applicable. As provided by law, Delinquent accounts constitute a lien
upon the real property for which the service was provided and the Property Owner is ultimately responsible for payment of
this account. If the amount due is not paid prior to 5:00 p.m. of date on the service disconnect/delinquency notice, service
MAY be interrupted and a reinstatement fee of $40.00 will be added to the account if a work order is prepared instructing
personnel to interrupt service for non-payment of account, not necessarily when the service is physically interrupted.
I hereby promise to pay all bills for such service when due, and abide by all ordinances regulating the use of City utilities
and any other rules and regulations which may be adopted by the City Council concerning said service. My signature also
indicates I have received the “City of Sweet Home-Important Information about your water/sewer account” pamphlet.
Applicant Signature Date Co-Applicant Signature Date
For Office Use Only
Deposit: Paid Amount: $ ___________ Receipt # _________________
Waived Transfer from Account # ___________________
Clerk: ____________ Property Owner Name: ____________________________ Owner Acct # ______________
Co-Applicant Name: _______________________________ Lot # ____________________
February 2019
