Applicant is:
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Select one:
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Landlord authorization

If applicant is a tenant, please provide the owner/landlord's contact information. Under state law provisions, a fully executed Landlord Authorization Form must accompany your request in order to establish water and/or sewer in a tenant’s name. Download and complete the Landlord Authorization Form (PDF) and upload it below.

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Primary applicant

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Secondary applicant

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Disclaimer
Personal information provided to James City County and/or the James City Service Authority (JCSA) in the form of email or electronic form is used solely to respond to your request, inquiry or transaction. James City County/JCSA does not sell or rent personal information to any third party organization. James City County/JCSA does not provide specific information about users or other personally identifiable data to unaffiliated third parties for their independent use, except if required to do so by the Virginia Freedom of Information Act (FOIA) or other law. As set forth in Section 2.2-3705.1(10) of the Code of Virginia, you may request that your electronic mail address be exempt from disclosure pursuant to a FOIA request. Should you wish for your electronic mail address to be exempt from disclosure pursuant to FOIA, please send an email to the County Webmaster.

Applicant is:
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Select one:
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Start date
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Stop date
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Landlord authorization

If applicant is a tenant, please provide the owner/landlord's contact information. Under state law provisions, a fully executed Landlord Authorization Form must accompany your request in order to establish water and/or sewer in a tenant’s name. Download and complete the Landlord Authorization Form (PDF) and upload it below.

Upload landlord authorization form
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Service address
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Home dialysis required
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Primary applicant

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Email
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Driver's license number
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Phone
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Secondary applicant

Secondary applicant name
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Email
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Driver's license number
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Phone
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Alternate phone
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Mailing/forwarding address
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Disclaimer
Personal information provided to James City County and/or the James City Service Authority (JCSA) in the form of email or electronic form is used solely to respond to your request, inquiry or transaction. James City County/JCSA does not sell or rent personal information to any third party organization. James City County/JCSA does not provide specific information about users or other personally identifiable data to unaffiliated third parties for their independent use, except if required to do so by the Virginia Freedom of Information Act (FOIA) or other law. As set forth in Section 2.2-3705.1(10) of the Code of Virginia, you may request that your electronic mail address be exempt from disclosure pursuant to a FOIA request. Should you wish for your electronic mail address to be exempt from disclosure pursuant to FOIA, please send an email to the County Webmaster.