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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