Start Service Request – Antioch City Hall

Resident Type *

Start Service Date *

Next Business Day Service, up to two weeks out, Monday – Friday. Retroactive Dates are not available

Service Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different than Service Address above)

Address Line 1

Address Line 2

City

State

Zip Code

Applicant Name *

First

Last

Applicant Drivers License Number *

Applicant Last 4 digits of Social Security Number *

Primary Phone *

Secondary Phone

Email *

Email

Confirm Email

Do you want to include a co-applicant? *

Co-Applicant Name

First

Last

Co-Applicant Drivers License Number

Co-Applicant Last 4 digits of Social Security Number

Have you had service in your name with the Antioch Water Department before? *

Previous Service Address

Address Line 1

Address Line 2

City

State

Zip Code

Please select how you would like to receive a Disconnection Notification below: *

Required Documents:

• Proof ownership (Grant Deed, Closing Disclosure, or Final Settlement Statement)
• Government issued ID.

Required Documents:

Lease/Rental Agreement
Government Issued ID
Verification of Tenancy Form

Required Documents:

Property Management Agreement

Upload Required Documents *

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City of Antioch
Water/Finance Department
200 H Street
ANTIOCH, CA 94509
(925) 779-7060
(925) 779-7054 fax
service@antiochca.gov

Applicant Acknowledgement

I hereby acknowledge the following:

I am requesting water service at the premises designated and agree to pay the rate prescribed by the City’s current Water/Sewer ordinance and Master Fee Schedule now in effect. (SUBJECT TO CHANGE)
If water is off: I understand it is MY RESPONSIBILTY to ensure ALL, the faucets and fixtures on the property are in the OFF position.
The City of Antioch will turn water ON whether I am present at the property or not and is not liable for any property damage or usage caused by failure to ensure all water sources are turned OFF.
PLEASE NOTE: I understand that the City of Antioch does not offer credits or adjustments for leaks on private property per the City Ordinance, and that failure to ensure all faucets/fixtures, as well as the main house valve, are OFF may result in high bills and/or water damage.
I understand that I shall be responsible for all charges for services relating to this application until the date I notify your office to discontinue services. Failure to request discontinuation of service will result in my being billed for any water usage/charges until I officially close the account in my name. A minimum deposit of $300 will be required for water service, pursuant to the Antioch Municipal Code 6-5.12; if I’ve had an account go to collections; or if my previous account(s) have had late or final notices issued.
A Water Setup fee of $30, along with valid government ID(s), are required to start service.
All payments not received by the City of Antioch by the due date will receive a 5% late fee. Failure to pay my monthly water bill(s) could result in water service suspension, late or final notices, calls, and emails. In the result of water interruption, subsequent fees associated with suspended services will be required, in order for service(s) to be reinstated.
All service requests are scheduled for the next business day. To obtain same day service, a same day service fee of $150.00 will be required.
Any tampering of the water meter will be charged a minimum tamper fee of $250.00.

City of Antioch
Water/Finance Department
200 H Street
ANTIOCH, CA 94509
(925) 779-7060
(925) 779-7054 fax
service@antiochca.gov

Applicant Acknowledgement

I hereby acknowledge the following:

I am requesting water service at the premises designated and agree to pay the rate prescribed by the City’s current Water/Sewer ordinance and Master Fee Schedule now in effect. (SUBJECT TO CHANGE)
If water is off: I understand it is MY RESPONSIBILTY to ensure ALL, the faucets and fixtures on the property are in the OFF position.
The City of Antioch will turn water ON whether I am present at the property or not and is not liable for any property damage or usage caused by failure to ensure all water sources are turned OFF.
PLEASE NOTE: I understand that the City of Antioch does not offer credits or adjustments for leaks on private property per the City Ordinance, and that failure to ensure all faucets/fixtures, as well as the main house valve, are OFF may result in high bills and/or water damage.
I understand that I shall be responsible for all charges for services relating to this application until the date I notify your office to discontinue services. Failure to request discontinuation of service will result in my being billed for any water usage/charges until I officially close the account in my name. A minimum deposit of $300 will be required for water service, pursuant to the Antioch Municipal Code 6-5.12; if I am a new tenant; if I’ve had an account go to collections; or if my previous account(s) have had late or final notices issued.
A Water Setup fee of $30, along with valid government ID(s), are required to start service.
All payments not received by the City of Antioch by the due date will receive a 5% late fee. Failure to pay my monthly water bill(s) could result in water service suspension, late or final notices, calls, and emails. In the result of water interruption, subsequent fees associated with suspended services will be required, in order for service(s) to be reinstated.
All service requests are scheduled for the next business day. To obtain same day service, a same day service fee of $150.00 will be required.
Any tampering of the water meter will be charged a minimum tamper fee of $250.00.

City of Antioch
Water/Finance Department
200 H Street
ANTIOCH, CA 94509
(925) 779-7060
(925) 779-7054 fax
service@antiochca.gov

Applicant Acknowledgement

I hereby acknowledge the following:

I am requesting water service at the premises designated and agree to pay the rate prescribed by the City’s current Water/Sewer ordinance and Master Fee Schedule now in effect. (SUBJECT TO CHANGE)
If water is off: I understand it is MY RESPONSIBILTY to ensure ALL, the faucets and fixtures on the property are in the OFF position.
The City of Antioch will turn water ON whether I am present at the property or not and is not liable for any property damage or usage caused by failure to ensure all water sources are turned OFF.
PLEASE NOTE: I understand that the City of Antioch does not offer credits or adjustments for leaks on private property per the City Ordinance, and that failure to ensure all faucets/fixtures, as well as the main house valve, are OFF may result in high bills and/or water damage.
I understand that I shall be responsible for all charges for services relating to this application until the date I notify your office to discontinue services. Failure to request discontinuation of service will result in my being billed for any water usage/charges until I officially close the account in my name. A minimum deposit of $300 will be required for water service, pursuant to the Antioch Municipal Code 6-5.12; if I’ve had an account go to collections; or if my previous account(s) have had late or final notices issued.
A Water Setup fee of $30, along with valid government ID(s), are required to start service.
All payments not received by the City of Antioch by the due date will receive a 5% late fee. Failure to pay my monthly water bill(s) could result in water service suspension, late or final notices, calls, and emails. In the result of water interruption, subsequent fees associated with suspended services will be required, in order for service(s) to be reinstated.
All service requests are scheduled for the next business day. To obtain same day service, a same day service fee of $150.00 will be required.
Any tampering of the water meter will be charged a minimum tamper fee of $250.00.

By typing or signing my name below, I knowledge above information is correct and true. *