CUSTOMER REQUEST FORM
SUBMIT AND ELECTRONICALLY SIGN YOUR DOCUMENTS ONLINE (START/TRANSFER WATER SERVICE ONLY)
Complete the form within an hour. Your progress will not be saved until you click Submit at the end. A countdown timer is displayed for your convenience. Refreshing the page restarts the timer, but you will lose all information.
* Indicates Required fields
Customer Information
First Name
*
:
Required
Last Name
*
:
Required
Service Address
*
:
Required
Contact Phone Number
*
:
Required
Account #
(if available)
Value must be numeric
Customer #:
(if available)
Value must be numeric
Email address
*
:
Invalid Format!
Required
Request Type
*
:
------------------ Select Type ------------------
Start/Transfer Water Service
Request Refund
Change of Billing Address
Downsize your Water Meter
New Construction including Upgrade or Relocation
Temporary Construction Water from Hydrant
Fire Flow Availability Request
Fire Sprinkler Design Information Request
Other
Required
Please upload the relevant document.
Attachments:
*
Comments:
Page not valid. The code you entered is not valid.
Type the code from the image
To process your request, please attach required documentation:
Start/Transfer Water Service:
Customer Order Form - DPW 92-0004
Continuity of Service Agreement (Landlords Only)
Copy of drivers license or other picture identification with signature
Copy of final closing statement or water letter from your escrow company or grant deed (Homeowners Only)
Request Refund:
Refund Request Form
Declaration of Household Income:
Declaration of Household Income form – PW 92-0061
Water Bill Appeal:
Water Bill Appeal form – PW 92-0062
Change of Billing Address:
Change of Address Form
Downsize your Water Meter:
Meter Reduction Form - WW 171 (Reduction Only)
Change to an Existing Water Service including Upgrade or Relocation/Fire Flow Availability Request:
WW620 - New water service checklist - (224KB)
New Service Connection - WW 172
Fixture Unit Determination - WW 174
WW1775 – Fire Flow Information Request Form
Summary of Water Demands - WW 190
Customer Order Form - DPW 92-0004
FFA195 - Fire Dept Information on Fire Flow Availability for Building Permit For Single Family Dwellings
FFA196 - Fire Dept Information on Fire Flow Availability for All Buildings Other Than Single Family Dwellings
Fire Flow Information Request CHECKLIST_Public Counter (2016) - (56KB)
Copy of drivers license or other picture identification with signature
Copy of Grant Deed, Fire Departments requirements, a plot plan, and subdivision requirements as applicable
Temporary Construction Water from Hydrant:
Temporary Construction Meter Application & Invoice
Construction Meter Removal Request
Fire Sprinkler Design Information Request
WW1775 – Fire Flow Information Request Form
Inspection
Inspection - General Inspection Request Form - (103KB)
Inspection - Unlock Request Form (for Antelope Valley Office ONLY) - (97KB)
Inspection - Certificate of Occupancy Request Form (for Antelope Valley Office ONLY for properties in the City of Lancaster) - (128KB)
WWD - Backflow Prevention Assembly Field Test and Maintenance Report Form - (29KB)
DPW Home
|
lacounty.gov
|
Site FAQ
|
Privacy & Security Policy
|
Terms of Use
|
Contact Us