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Notification Of Ownership Change Form

PROPERTY INFORMATION

*Service Address

Assessors Parcel Number (APN)

Lot Number

*Title Company Name & Location

*Close of Escrow/Ownership Change Date

PROPERTY OWNER INFORMATION

*Applicant Is

*Owner Name

*Owner Mailing Address

*Owner Email Address

*Owner Telephone

IN CARE OF BILLING INFORMATION

Check This Box If The Billing Information Is the Same As That Of The Property Owner Mailing Address

In Care Of Billing/Company Name

Company Mailing Address

Company Email Address

Company Telephone

*By checking this box, I, as applicant understand the rules, regulations and ordinances of the Northstar Community Services District (NCSD) pertaining to the use of its services and the charges established for their use shall apply and owner/applicant agrees to be bound thereby, now and in the future. The NCSD and its representatives shall be kept free and harmless from any claim or claims whatsoever arising from connection to NCSD’s systems. Any changes in the use of the property, number of plumbing fixtures or other billing factors subsequent to issuance of this receipt which result in higher factor rating will result in the assessment of additional connection charges and service charges on the property. Any changes which result in lower usage of the system may result in lower service charges on the property. It is the responsibility of the property owner to notify NCSD of any changes. Ratings made from submitted plans will be later field-inspected and may be adjusted the inspection. NCSD has the right to periodically inspect the property to establish the property factor rating for the property. Commercial properties are generally inspected on a biennial basis. NCSD Connection Fees are non-refundable charges unless sewer/water permit is cancelled prior to connection. NCSD connections may not be transferred to another parcel. Final approval shall not be granted until all fees are paid, and all requirements are complete.

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