RSA MD5 Message-Digest Algorithm RSA MD5 Message-Digest Algorithm
Fire Service Request for Available
Flow and Pressure Information
Before applying for a private fire service with EBMUD, applicants for commercial and multi-family structures of five or more units must submit this form for the property requiring a fire service installation. Click here to see if you meet this requirement. If you do not meet this requirement, click here to access the appropriate form.

Note: a $369 fee will be charged for this fire service request.

Billing & Contact Information
First Name*
Last Name*
E-mail*
Address #*
Street*
Company Name
Apartment
City*
Zip*
Main Phone*
Alternate Phone
Fax
* required fields

Property Information
Address #*
Street*
City*
   Zip*
    
Assessor's Parcel #

Approximate Elevation (in feet)

Fire Service Connection Size (if available)
Design Flow in GPM (if available)
Property Type (required)

Please provide a detailed description of your request for fire service below.
Please include all possible fire service connection locations measured from centerline of nearest cross street.  Be as specific as possible.
Example (click here for sample map):
feet of on side of

Location 1: (required)
feet of on side of
Location 2:
feet of on side of
Location 3:
feet of on side of

Comments

Payment Information  (required)
Credit Card:
Card Number: (no spaces or dashes)
Expiration Date:   

Your request is not complete until you press the Submit button below. Ensure that all the above information is correct. After pressing the Submit button below, you will not be able to modify your request. Do not click the Back or Refresh buttons, and click the Submit button only once.