Application for Water Service

If you recently moved to Story City, we want to welcome you and invite you to fill out our application to start your water service with the city! If you recently moved within Story City, please fill out this form to notify us of the new address you need water service at.

Your Information

Name(Required)

First Middle Last

Date of Service Start(Required)

Service Address(Required)

Street Address City ZIP Code

Are you renting?(Required)

Yes

Landlord Name(Required)

Landlord Phone(Required)

Mailing Address (if different than service address)

Street Address City ZIP Code

Phone(Required)

Email(Required)

Date of Birth(Required)

Last 4 Digits of Social Security Number

Your Employer(Required)

Employer Address

Do you have a spouse or roommate living at this location?(Required)

Yes

Spouse/Roommate Information

Roommate/Spouse Name(Required)

First Middle Last

Roommate/Spouse Phone(Required)

Roommate/Spouse Email(Required)

Roommate/Spouse Date of Birth(Required)

Roommate/Spouse Last 4 Digits of Social Security Number

Roommate/Spouse Employer(Required)

Roommate/Spouse Employer Address

Emergency Contact Information

Relative/Contact Person Name(Required)

Relative/Contact Person Phone(Required)

Rentals Only: Deposit required – $125.00 due with application

By submitting this application, I hereby apply to the City of Story City Water Utility for utility service to be delivered at the service address and start date listed above, in accordance with Utilities rules. I agree to pay all bills rendered for utility consumption until I notify the Utility Office to discontinue said service.

Signature(Required)

Date of Application(Required)

CAPTCHA

Attention Renters!
Next Step: please proceed to our payment portal to complete your payment! A $125 fee is required for rental applicants.

After you submit the form, you will be directed to complete your payment on our payment portal.

This field is for validation purposes and should be left unchanged.

Application for Water Service

Your Information

Spouse/Roommate Information

Emergency Contact Information

Attention Renters!
Next Step: please proceed to our payment portal to complete your payment! A $125 fee is required for rental applicants.

After you submit the form, you will be directed to complete your payment on our payment portal.

Contact Us

Quick Links

Affiliates

Make A Payment

Rent Facilities

Application for Water Service

Your Information

Spouse/Roommate Information

Emergency Contact Information

Attention Renters!Next Step: please proceed to our payment portal to complete your payment! A $125 fee is required for rental applicants.

After you submit the form, you will be directed to complete your payment on our payment portal.

Contact Us

Quick Links

Affiliates

Make A Payment

Rent Facilities

Attention Renters!
Next Step: please proceed to our payment portal to complete your payment! A $125 fee is required for rental applicants.