Residential Application for Water Service

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

No

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

No

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)

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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.

Name

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

Back Row (L to R): Brian Watson, Chris Conklin, Jamie Beck, Chris Engelhardt, Ben Harriman, Trent Whipple, Ryan Charlson, Eric Norris
Middle Row (L to R): Jake Severson, Tanner Stevens, Justin Braland, Kevin Doyle, Dave Kost, Lysle Macdonald
Front Row (L to R): Berry Saunders, Tyler Oberender, Ryan Peterson, Travis Doyle
Not Pictured: Adam Tryon, Issac Rahto, Adam Holm, Jake Edwards

Officers and Firefighter Members

Lysle Macdonald (Fire Chief) Jamie Beck (1st Asst. Chief) Ryan Peterson (2nd Asst. Chief) Jake SeversonTyler Oberender (Sec/Treas) Chris Engelhardt (Safety Officer) Eric Norris Tanner Stevens Justin Braland Travis Tinken Adam Tryon Jake Edwards
Trent Whipple (Training Officer) Brian Watson (Training Officer) Kevin Doyle (Safety Officer) Travis Doyle (Training Officer) John Lamb Dave Kost Ben Harriman Issac Rahto Ryan Charlson Chris Conklin Berry Saunders Adam Holm

Retired Members

Sam Peterson (2017) Ben Knutsen(2017) Jim Beck(2017) Brian Pringle (2016) Greg Gerjets (2014) Scott Richardson (2014)
Kathy Twedt (2013) Adam Lande (2011) ChrisCrutchfield (2011) Don Olson (2010) Scott Nibe (2010) Justin East (2009)

Back Row (L to R): Brian Watson, Chris Conklin, Jamie Beck, Chris Engelhardt, Ben Harriman, Trent Whipple, Ryan Charlson, Eric Norris
Middle Row (L to R): Jake Severson, Tanner Stevens, Justin Braland, Kevin Doyle, Dave Kost, Lysle Macdonald
Front Row (L to R): Berry Saunders, Tyler Oberender, Ryan Peterson, Travis Doyle
Not Pictured: Adam Tryon, Issac Rahto, Adam Holm, Jake Edwards

Officers and Firefighter Members

Lysle Macdonald (Fire Chief) Jamie Beck (1st Asst. Chief) Ryan Peterson (2nd Asst. Chief) Jake SeversonTyler Oberender (Sec/Treas) Chris Engelhardt (Safety Officer) Trent Whipple (Training Officer) Brian Watson (Training Officer) Kevin Doyle (Safety Officer) Travis Doyle (Training Officer) Eric Norris Tanner Stevens Justin Braland Travis Tinken Adam Tryon Jake Edwards John Lamb Dave Kost Ben Harriman Issac Rahto Ryan Charlson Chris Conklin Berry Saunders Adam Holm

Retired Members

Sam Peterson (2017) Ben Knutsen(2017) Jim Beck(2017) Brian Pringle (2016) Greg Gerjets (2014) Scott Richardson (2014) Kathy Twedt (2013) Adam Lande (2011) ChrisCrutchfield (2011) Don Olson (2010) Scott Nibe (2010) Justin East (2009)