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2. Residential Services Application

   City of Deer Park

   New Service Application

   710 East San Augustine • Deer Park, TX • 77536 • (281) 478-7221

   Deposit/Credit History

   Pursuant to Ordinance Sec. 106-24 all residential new service applicants residing in a home are required to pay a $125 deposit OR provide a credit history from another water service showing no late payments within the most recent 12 month period. For business service or rental property applicants please contact the Water Department for deposit information as these do not qualify for deposit waivers.

   Confidentiality of Personal Information

   Pursuant to the provisions of Section 182.052 of the Utilities Code all information on your account will remain confidential unless otherwise specified. If you would like to waive the confidential status of the account please request the Utility Disclosure Form.

4. Account Holder Name*
6. Driver's License or ID #*
7. Phone*
9. Authorized User Name
11. Driver's License or ID #
12. Phone
14. Site Address*
15. Service Start Date*
    Service Start Date
17. Mailing address (if different than site address)
19. Paperless Billing

    1. Check here for paperless email billing. Leave unchecked for regular mailed bill
20. Email
22. Acknowledgement*

    1. I/We understand

24. By checking this box, I give permission to the City of Deer Park to utilize all information in any effort to attempt communication; this includes automatic telephone dialing systems. I am also agreeing to pay for City provided utilities and applicable fees at this address. Not receiving a bill does not waive payment or penalties. Unpaid balances are subject to disruption of services and collection action. Any deposits and credits left on water accounts may be used to cover any balances due for other City of Deer Park billed services.

26. Note: The City of Deer Park and the City of Pasadena have entered into an Interlocal Agreement to aide in collection of unpaid water, sewer and/or garbage service fees. Any unpaid amounts with either City may result in disruption of service until paid.

    Completed Applications

    New Service Applications are considered complete with a deposit or credit history, copy of lease or purchase agreement, and a copy of a valid driver’s license or photo identification. These elements must be present in order to establish new water service. Additional documentation could be required upon request. All applications received after noon Monday-Thursday and after 10 am on Fridays will not be processed until the following business day.

28. City of Deer Park Service Agreement

    City of Deer Park 

    Service Agreement

    Public Water System ID#1010007

    1. Purpose - The City of Deer Park is responsible for protecting the drinking water supply from contamination or pollution which could result from improper plumbing practices. The purpose of this service agreement is to notify each customer of the plumbing restrictions which are in place to provide this protection. The utility enforces these restrictions to ensure the public health and welfare. Each customer must agree to this agreement before the City of Deer Park will begin service.  In addition, when service to an existing connection has been suspended or terminated, the water system will not re-establish service unless it has a signed copy of this agreement. This information complies with the requirements of Chapter 290 of the TCEQ Rules and Regulations for Public Water Systems.
    2. Plumbing Restrictions - The following unacceptable plumbing practices are prohibited by State regulations:
       1. No direct connection between the public water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow device.
       2. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.
       3. No connection which allows water to be returned to the public drinking water supply is permitted.
       4. No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing at any connection which provides water for human use.
       5. No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which provides water for human use.
    3. Service Agreement - The following are the terms of the Service Agreement between the City of Deer Park and the customer:
       1. The City of Deer Park will maintain a copy of this agreement as long as the customer and/or the premises are connected to the water system.
       2. The customer shall allow their property to be inspected for possible cross-connections and other unacceptable plumbing practices. These inspections shall be conducted by the City of Deer Park or its designated agent prior to initiating new water service: when there is reason to believe that cross-connections or other unacceptable  plumbing practices exist; or after any major changes to the private water distribution facilities. The inspections shall be conducted during the City of Deer Park's normal business hours.
       3. The City of Deer Park shall notify the customer in writing of any cross-connection or other unacceptable plumbing practices which has been identified during the initial inspection or the periodic reinspection.
       4. The customer shall immediately correct any unacceptable plumbing practice on their property.
       5. The customer shall, at their expense, properly install, test, and maintain any backflow prevention devices required by The City of Deer Park. Copies of all testing and maintenance records shall be provided to The City of Deer Park, annually if required.
    4.  Enforcement - If the customer fails to comply with the terms of the new Service Agreement, the City of Deer Park shall, at its option, either terminate service or properly install, test and maintain an appropriate backflow prevention device at the service connection. Any expense associated with the enforcement of this agreement shall be billed to the customer. 
30. Service Agreement Acknowledgement*

    1. By checking this box, you affirm you have read and understand the service agreement terms
31. Date*
    Date

    Today's date

33. Liability Release and Assignment of Responsibility Agreement

    ** THIS IS A LIABILITY RELEASE. PLEASE READ COMPLETELY BEFORE FINISHING APPLICATION **

    To prevent water damage, always turn off your main water valve or all faucets and hose connections before water service is restored. The owner, tenant, authorized agent, or representative is responsible for verifying that there are not any leaks within the premises.

    There are 2 options for having water connected:

    Option 1: I am aware that I will need to be at the residence between 2pm and 4pm Monday-Thursday or 10am-11am on Fridays on the date service is connected if the service is currently disconnected in the water billing system. It is the applicant’s responsibility to inspect the inside of the residence for any possible leaks and notify the technician immediately so water can be turned off for any repairs.

    Option 2: I am waiving liability of the city for the connection of services. No one will need to be at the property for inside inspection of the home. I do release and discharge The City of Deer Park and its employees from all claims, damages, and causes of action which may arise from turning on water service at the below following property. I understand that by signing this form I am taking responsibility for any damages that may occur when service is established at the address in conjunction with this application. Turning services on unattended may lead to water damage and/or flooding inside the home if leaks are present or faucets are not in the off position.

35. Please select the option you choose below*

    1. Option 1 - I will be at the home between 2pm and 4pm Monday-Thursday or 10am-11am on Friday, to sign the liability release to inspect the inside of the home and release libaility at that time. I understand and agree (Service Connection Times and Liability Release)
    2. Option 2 - I will not be at home between 2pm and 4PM and release liability at this time. I WILL NOT hold the city, its employees, or its representatives responsible for any damages that may occur during this service turn on. I understand and agree (Servcice Connection Times and Liability Release)
37. Please select one of the following:

    I am the/an: 

    1. owner
    2. tenant
    3. authorized agent or representative

39. of the property set forth above do release and discharge The City of Deer Park and its employees from all claims, damages, and causes of action which may arise from turning on water services at the above listed property. I understand that by entering my name on this electronic form, I am taking responsibility for the turning on of water service at the above listed address

41. Full Name*
42. Today's Date*
    Today's Date
44. Upload Files and Images

    Upload lease/purchase agreements, ID and other docs here

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

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