Home Service Application

Apply for Home Service
Welcome to Public Utilities Online Application for water & sewer services.

Copies of the following related documents are required for upload:

1) Government Photo ID,

2) signed Lease, and/or signed settlement.

Please Note: All documents are required for submittal before account can be established. Water and/or sanitary sewerage disposal service may not be turned on until this application/agreement is completed, signed, and returned to the Department of Public Utilities. The existing account balance must be current. Arrears must be paid in advance of service transfer.

If you have any questions, call us at 757-382-6352, or email us at water@cityofchesapeake.net. You will be contacted to complete the registration process to set up your new account after your application and related documents are received. The Department reserves the right to require customers to appear in person and present photo identification or other required documentation.
Date Service On*

MonthDayYear
Date
Applicant Information
Name*

First NameMiddle NameLast Name
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer
Home or Cell Phone*
Home or Cell Phone
Social Security Number*
Email*
example@example.com
Is there more than one applicant?*

YesNo

Applicant 2 Information
Applicant 2: Name*

First NameMiddle NameLast Name
Applicant 2: Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
Applicant 2: Employer
Applicant 2: Home Phone
Applicant 2: Cell Phone
Applicant 2: Social Security*
Applicant 2: Email
example@example.com

Documentation
Secure Document Upload

1) Upload a copy of a driver's license for each application.

2) If you are a tenant, please upload a signed copy of your lease. If you are a recent owner (less than 30 days), please upload signed copy of settlement statement or closing disclosure.
You may drag and drop your files, or browse and select your files.
Cancelof
Files size: We recommend file(s) smaller than 4MB.
Accepted file extensions: pdf, doc, docx, png, jpg, jpeg, png, gif

NOTE: If you choose not to upload your documentation, please select the Preview PDF button on the next page, print, sign, and deliver it to: Public Utilities, 306 Cedar Road, Chesapeake, VA 23322 with copy/copies of driver’s license for each applicant along with lease or ownership documents as applicable.

Agreement & Signature
Home Service Application's Terms and Conditions*
Applicant Signature*

Clear
Applicant 2: Signature*

Clear

Public Utilities requires an adult to be present to turn on water service. If no one can be present and you would like to sign a release form please mark the check box below to review the release form.*

No one will be home when Public Utilities turns on water service. I will review and sign the release form.Someone will be home when Public Utilities turns on water service.
Release Form

Authorization to Turn on Water
The individual whose signature is affixed below, hereafter known as the Applicant, does hereby authorize the Department of Public Utilities, for the City of Chesapeake, to reinstate the water and sewer service to his and/or her property, and/or in the case of rental property, does hereby accept any and all responsibility for such turn-on. The Applicant further agrees to release and discharge said City of Chesapeake, Department of Public Utilities, from any and all liability for any and all damages to the property, including the inside and outside structure, as a result of water and/or sewer damages.

The Applicant further agrees that all water faucets and fixtures shall be turned off. If, at the time of the turn-on of water by the City, the meter indicates there is water flowing through the meter, the water will immediately be turned off. It is understood this action is necessary because water flowing through the meter indicates there is a faucet which is running or possibly a leaking or broken water pipe. The next turn-on will require that the Applicant be present at the property during the turn-on.

The Applicant has read this agreement and herewith affixes his or her signature below. This agreement having been instituted as a result of the Applicant’s inability to have someone present in the home at the time of the instatement or reinstatement of his or her water and sewer service. This document should only be completed after the applicant has completed application for water service with the Department of Public Utilities, for the City of Chesapeake.
Release Form Signature

Clear
Todays Date

MonthDayYear
Todays Date
Should be Empty:

Apply for Home Service

Applicant Information

Applicant 2 Information

Documentation

Agreement & Signature

Release Form