HomeMy WebLinkAboutSewer Billing Change Request Form 2018-01Hawai`i County is an Equal Opportunity Provider and Employer rev 01/2018
COUNTY OF HAWAI‘I DEPARTMENT OF ENVIRONMENTAL MANAGEMENT WASTEWATER DIVISION
345 KEKŪANĀO`A STREET, SUITE 41, HILO HI 96720
PHONE: (808) 961-8338 FAX: (808) 961-8086
EMAIL: WWDACCTNG@HAWAIICOUNTY.GOV
SEWER BILLING CHANGE REQUEST FORM
Pursuant to the Hawai‘i County Code, Chapter 21, Article 4, Section 21-32(c), “Charges for sewer service shall be billed to the owner or owners…” of
the property. Wastewater will bill a designated party if the property owner(s) submit a request “…in writing and signed by all parties involved, including
all property owners and the designated person. The property owners and the designated person shall be jointly and severally liable for the entire sewer service charge without further notice of any delinquency to the property owners.”
Also, the Hawai`i County Code, Chapter 21, Article 4, Section 21-32(e) states that if any sewer service charges are “…not paid when due, it shall be
deemed delinquent and may be recovered by the county by a civil action filed against the property owners, or the designated person, or both.”
Owner(s) shall be responsible for notifying the Wastewater Division of any changes.
Section 1: PROPERTY / BILLING INFORMATION:
Street Address: Effective Date of change:
City, Zip code: TMK #:
Account #: Customer #:
Section 2: OWNER(S)’ INFORMATION (Attach additional sheets as necessary)
Name (Primary owner):
Mailing Address:
City: State: Zip Code:
Home ph #: Cell Ph #: Work Ph #:
Owner’s Signature: Date:
Print Name and Title
(If owner is not an individual)
Section 3: DESIGNATED PARTY TO BE BILLED
Designee is: Tenant Property Manager Other
Name:
Mailing Address:
City: State: Zip Code:
Home ph #: Cell Ph #: Work Ph #:
Designee’s Signature: Date:
Section 4: CLOSING / FORWARDING INFORMATION
Account Holder(s)’
Name:
Forwarding
Address:
City: State: Zip Code:
Home ph #: Cell Ph #: Work Ph #:
Signature: Date:
Hawai`i County is an Equal Opportunity Provider and Employer rev 01/2018
COUNTY OF HAWAI‘I DEPARTMENT OF ENVIRONMENTAL MANAGEMENT WASTEWATER DIVISION
345 KEKŪANĀO`A STREET, SUITE 41, HILO HI 96720
PHONE: (808) 961-8338 FAX: (808) 961-8086
EMAIL: WWDACCTNG@HAWAIICOUNTY.GOV
SEWER BILLING CHANGE REQUEST FORM
INSTRUCTIONS
If you have received this form with any portion pre-filled, please verify all information for accuracy and make any
necessary corrections.
Section 1: PROPERTY / BILLING INFORMATION:
- Street Address / City, Zip code: physical / site address
- Effective Date of change:
- Designating an account: Enter the date to begin billing the designated party for services
Note: We are unable to retroactively bill. Please see latest Wastewater bill received for the last service dates that have already
been charged
- Closing an account: Enter the last date to be billed for services (New billing will start the day after)
- TMK #: Property’s Tax Map Key (this information is on your wastewater bill)
- Account #: On the Wastewater bill, this eleven (11) digit number is separated by decimal points (i.e. xxx.xxxxx.xxx)
- Customer #: On the Wastewater bill, this seven (7) digit number begins with “00”
Section 2: OWNER(S)’ INFORMATION:
- Complete all information for each person listed on title for the property
- If a Property Management Company that has already been designated by the owner(s) is signing on behalf of said
owner(s), complete this section with the Property Management Company’s information.
- Only one (1) trustee / executor is necessary to sign on behalf of a trust.
- Use additional sheets as necessary.
Section 3: DESIGNATED PARTY TO BE BILLED:
- Complete all information for Designee
- If Designee is a Property Manager, please submit management agreement page(s) that show all parties involved with
the agreement, the date of the agreement, and the signature page of all parties involved.
Section 4: CLOSING / FORWARDING INFORMATION
- Complete all information for the account being closed
- If property has been sold, please submit the cover page of your escrow documents as we will need the information of
the Seller, the Buyer and the date the sale has been recorded with the Bureau of Conveyances.
Billing change requests will be done with the next billing cycle, dependent upon the timing of the receipt of the
completed form.
This form is not considered complete if there is missing documentation and/or signatures.
NOTE: It is the owner(s)’ responsibility to notify the Wastewater Division of any changes, as, pursuant to the Hawai`i
County Code, Chapter 21, the property owner(s) are ultimately liable for any and all fees. The Hawai`i County Code,
in its entirety, can be found at www.hawaiicounty.gov.