Application for Leak Adjustment

This leak adjustment application MUST be filled out COMPLETELY and received at the Utility Accounting office (Room 106) in City Hall within 3 months of the repair to be considered for a leak adjustment credit. The credit will only apply to the last three billing periods ending with the repair date.

*Account #:

*Account Name:

*Address:

*Phone #:

Email:

Date leak was repaired:

Do you know how long the leak was going on?

Who did the repair?

Type of leak or repair:

Where did the water go? (exp down drain)

Number of people living here?

Any water changes in the last year or going forward for the next month?
(exp: occupancy, water savers installed, watering)