Application for Pool Adjustment


To be considered for a pool adjustment the water bill must be current (no past due balance). Only one pool filling will be adjusted in a year and this includes partial fillings. The adjustment will appear on a future bill. A pool adjustment means you will pay for the water used but not the sewer portion of it. This pool adjustment application MUST be filled out COMPLETELY and received at the Utility Accounting office (Room 106) in City Hall within 3 months of filling your pool.

*Account #:

*Account Name:

*Address:

Phone #:


Email:


Date pool was filled:

Beginning Reading:

Ending Reading:

Pool Permit #:

Pool Shape:

Length or Diameter:

Width:

Depth Shallow End:

Depth Deep End:

Gallon Capacity:

Did you fill from empty?:
If not how full? (exp 1/2 full):