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Water Service Request Form

2. Service

   1. Meter Test
   2. Construction Water
   3. Turn-On
   4. Turn-Off & Meter Removed

3. Reason

   1. Temp Shut-Off
   2. Seasonal
   3. Demolition
   4. Repair

5. Today's Date*

6. Requested Date*

8. Phone Number*

9. Requested By*

11. When Service to Be Done*

13. Property Owner*

14. Account Number*

16. Property Address*

18. Block*

19. Lot*

20. Qual

22. Fee

    1. Cash
    2. Check
    3. To Be Billed

23. Check Number

    If applicable, provide the check number

25. Date Final Billing Done

27. Additional Information
    Final bill must be paid prior to issuing a letter to the building department. Checks are held for a meter test. Results of the meter test determine the return of the check.

    Final bill must be paid prior to issuing a letter to the building department. Checks are held for a meter test. Results of the meter test determine the return of the check.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field