I hereby request that water service be disconnected at the service address listed on this form. I understand that my deposit will be refunded once all outstanding balances have been paid in full.

I acknowledge that if I wish to reinstate service in the future, I may be required to reapply as a new customer and pay all applicable fees in accordance with the then-current Riverside Special Utility District Service Policy. I further understand that the ability to restore service will depend on available system capacity, which may be limited and could require capital improvements to deliver adequate service. I acknowledge that any such improvements will be at my expense.