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Request for Sewer Credit

2. 

3. REQUEST FOR SEWER CREDIT

5. NAME ON ACCOUNT*

6. ACCOUNT NUMBER*

8. SERVICE ADDRESS*

9. BEST CONTACT PHONE*

11. EMAIL ADDRESS*

13. Requirements to qualify for a sewer credit:
    <br/>1. Sewer Credits are limited to once in a twelve (12) month period. <br/>2. The consumption must exceed your 6 month average. <br/>3. Attach a copy of the repair bill, pool contract or provide a statement explaining when and how the repair was made with copies of receipts for repair supplies.

    
    1. Sewer Credits are limited to once in a twelve (12) month period.
    2. The consumption must exceed your 6 month average.
    3. Attach a copy of the repair bill, pool contract or provide a statement explaining when and how the repair was made with copies of receipts for repair supplies.

15. NO REQUEST WILL BE PROCESSED WITHOUT VERIFICATION OF THE REPAIR

17. Sewer credits will NOT be granted for the following reasons:
    <br/>1. Broken or leaky water lines where the water enters the sanitary sewer system. (i.e. leaky toilets or inside faucets) <br/>2. Water used for irrigation. <br/>3. Negligent use of water. <br/>4. Underdetermined use of water.

    
    1. Broken or leaky water lines where the water enters the sanitary sewer system. (i.e. leaky toilets or inside faucets)
    2. Water used for irrigation.
    3. Negligent use of water.
    4. Underdetermined use of water.

19. REASON FOR REQUEST FOR SEWER CREDIT

21. 1. POOL FILL

    1. NEW
    2. EXISTING
    3. REPAIR (attach copy of repair bill)

22. POOL TYPE

    1. BUILT IN
    2. ABOVE GROUND

24. Date/Range of Consumption

25. # of Gallons Required

27. *Must attach a copy of pool specifications and/or pool dimensions for above ground*

29. 2. LEAK (other than pool leak)

30. Date/Range for Consumption

32. Brief description of water leak including location of problem:

34. I UNDERSTAND THAT THIS FORM MUST BE FILLED OUT COMPLETELY FOR MY ACCOUNT TO BE CONSIDERED FOR A SEWER CREDIT

    I UNDERSTAND THAT THIS FORM MUST BE FILLED OUT COMPLETELY FOR MY ACCOUNT TO BE CONSIDERED FOR A SEWER CREDIT

36. SIGNATURE OF ACCOUNT HOLDER*

    Type your name

37. TODAY'S DATE*
    TODAY'S DATE

39. ATTACHMENT

40. ADDITIONAL ATTACHMENT

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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