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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:
    
    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:
    
    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
36. SIGNATURE OF ACCOUNT HOLDER*
    Type your name
37. TODAY'S DATE*
    TODAY'S DATE
39. ATTACHMENT
40. ADDITIONAL ATTACHMENT
Leave This Blank:


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

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