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City of Brentwood - Finance & Information Systems
Home  Finance & Information Systems

Water Sewer Garbage Application
  * Required Fields

*New Service Address:
 
Applicant's Information
*Email Address : *Send my bill via email: Yes No
*Last Name: *First Name:
*Date of Birth: *Last 4 digits of SS#
Primary Phone: Secondary Phone:
*DL/ID #
Mailing Address (if different than service address):
City: State: Zip:
Choose one:
 
Co-Applicant's Information
Co-Applicant Last Name: First Name:
Date of Birth: Last 4 digits of SS#
DL/ID #    
     
SERVICE INFORMATION  
   
*Water Service Start   Date: (Monday through Friday except holidays, please submit request by 12:00 pm for same day activation).
     
Garbage Service - Service consists of weekly pick-up of a Garbage Cart (brown). The Recycling Cart (blue) or Yardwaste Cart (green) will be picked-up on alternating weeks. Carts come in 3 sizes (32, 64, or 96 gallons). The monthly fee is based on the size of your brown cart.
Check One:
GARBAGE (Brown): None 32 gal. @ $23.35/month 
RECYCLE (Blue): None 32 gal. (No fee)              64 gal.(No fee)            96 gal. (No fee)
YARDWASTE (Green): None 32 gal. (No fee)            64 gal.(No fee)           
   
Desired Date of Cart Delivery: (Monday-Friday except holidays) Please submit request by noon for next day delivery. Your service will begin on the next weekly pick-up day after cart delivery.
 
 

By submitting this application, I hereby acknowledge that I am requesting utility services at the above address. I hereby agree to pay the rate prescribed by ordinance now in effect or hereafter enacted. I understand that I shall be responsible for all charges for service relating to this application until the date I notify your office to discontinue services. I understand my monthly bill will include water base, water usage, sewer, sewer lateral and garbage charges for service requested. Bills are due upon presentment. A 5% penalty will be assessed if not paid by the due date. Any bill in delinquent status that requires a discontinuance of service(s) will require the delinquent bill to be paid in full, as well as reconnection fee, in order for service(s) to be reinstated. In accordance with the City Council Administrative Policy 10-2, utility customer information shall be provided consistent with Government Code Section 6254.16.

I have read and understand the information above and agree to them by initializing below. If this account is for a business, I certify that I am authorized to initial on behalf of the business.

 
*Applicant's Initials
 
 
 
Finance & Information Systems       (925) 516-5460
150 City Park Way       (925) 516-5401
Brentwood, CA 94513