Lakehaven Assistance Application

The Lakehaven assistance program is for Lakehaven Water & Sewer District customers only. To apply you must have a current and valid shut-off notice from Lakehaven. The maximum benefit amount is $100 one time per calendar year.

Eligibility income guidelines are based on HUD 80% of King County Median income for your family size.

Please have all documents ready to upload before submitting your request. Please note the application will NOT be processed if required documents are missing due to limited funding. Applications will be processed as first come first serve basis.

The following documents are required:

Official form of identification verifying the identity of each household member. Examples of identification may include a social security card, an identification card, or a birth certificate.
The applicant/bill holder‘s valid (non-expired) photo ID with birth date.
Proof of all household income received during the one full month prior to the month you are submitting your application (do not include the current month). This must include income for any occupant of your household age 18 years or older at the time of your application.
Current rental agreement or mortgage statement.

Name(Required)

First Last

Date of Birth(Required)

Please provide your date of birth. Please include month, date, and year.

Social Security Number(Required)

Please provide the last four digits of your social security number.

Household Size(Required)

Please provide the number of people living in your household. Include all occupants regardless of age.

Household Income(Required)

Please provide the total of all household income received during the one full month prior to the month you are submitting your application. For example, if you are submitting your application in June, please include all income for the month of May only. This must include income for any occupant of your household age 18 years or older at the time of your application.

Lakehaven Utility Account Number(Required)

Please provide your utility account number for Lakehaven.

Do you have a current and valid shut-off notice from Lakehaven Water & Sewer District(Required)

Yes

Shut-off date (if available)

Address(Required)

Address must be your current address.

Street Address City State ZIP / Postal Code

Phone(Required)

Email(Required)

Document Upload(Required)

Please upload the required documents listed above. If you do not have a scanner, you make take photos with your phone. Please make sure all information is legible.

Drop files here or

Accepted file types: pdf, jpg, gif, png, Max. file size: 128 MB.

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