The District charges actual cost based on time and materials for W1 or S1 form completion. Upon review, more information may be required of the customer and more time and/or materials may be necessary, increasing actual cost involved.

A cost reconciliation will be completed to determine the final cost. The customer will be billed for any additional actual cost and the signed letter will be provided upon receipt of payment. A refund will be forthcoming if the actual cost is less than quoted/paid.

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W1 / S1 Form Request

Applicant Name (required)

Applicant Phone Number (required)

Applicant Mailing Address; House Number & Street (required)

Mailing Address City (required)

Mailing Address State (required)

Mailing Address Zipcode (required)

Applicant Email (required)

Parcel / APN Number (required)

Parcel Address (required)

Select the type of request needed for the project: (required)

W1 Letter

S1 Letter

What is your project type? (required)Residential (Single Family Residence)Commercial (Duplex, Institutional, Multi-Family Residence)

What size meter(s) does your project require? (required)

1" (One inch)

1.5" (One and one-half inch)

2" (Two inch)

3" (Three inch)

Please upload any required documentation (Plot Plans)

I understand that this form is the start of the process and that I may be asked to submit further information and may be billed or refunded for any actual cost difference. (required)

Yes, I understand.

What type of project are you proposing? (required)

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IMPORTANT: Please allow up to two (2) weeks for processing, due to the high volume of requests. This form will be submitted to Customer Service, who will email you the total amount due and instructions to pay online. Once payment has been made, reply to the Customer Service email with your payment confirmation number. Customer Service will reply with a confirmation that it was received and begin processing your request.

By signing this document, I am certifying that the statements and information provided are true and accurate. I also understand that if at any time Joshua Basin Water District discovers that these statements are incorrect and that pose a health hazard, it may result in my water service being turned off. (required)

Yes

No

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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