COUNTY OF LAKE



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SPECIAL DISTRICTS ADMINISTRATION

LETTER OF RESPONSIBILITY

Lake County’s Water and Wastewater Agency |

230 N. Main Street

Lakeport, California 95453

Telephone 707-263-0119

Fax 707-263-3836

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Sewer utility account – No water service

Today’s Date: _________________ Date the bank took ownership: ________________________

I, ____________________________ acting in my role as_________________________________

(name of signatory) (position)

for __________________________________ will take full responsibility for the sewer service

(name of company)

located at _____________________________________ in the city of_______________________.

Phone Number______________________ Alternate Phone Number ________________________

Mailing Address: _________________________________________________________________

(City) (State) (Zip)

Please read and initial

______ Lake County Special Districts’ sewer bills not paid by the due date will have a late fee

of $5.00 added to the account.

______ I understand that I must give notice in writing ending service.

______ If the final bill is not paid within 30 days, the account will be sent to a Collection Agency and reported to all Credit Bureaus.

BY SIGNING BELOW, I HEREBY AGREE TO ABIDE BY THE RULES AND REGULATIONS ESTABLISHED BY THE COUNTY OF LAKE FOR THE WASTEWATER DISTRICT.

____________________________________________ _________________________________________

Care of Date Approved By Date

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OFFICE USE ONLY:

Account Number: ___________________________

Service Request Number ____________________

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