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Application Form_3-21-25.docx
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City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.oshkoshwi.gov
Return to Tracy Taylor:
Via e-mail: DPW@oshkoshwi.gov
Via mail: Department of Public Works
PO Box 1130
Oshkosh, WI 54903-1130
In person: Room 301, City Hall
215 Church Avenue
PUBLIC-SIDE LEAD or GALVANIZED (CONSIDERED LEAD)
SERVICE LINE REPLACEMENT REQUEST
This application is only for properties where the private-side water service line has
been replaced to be lead free prior to August 8, 2024 and the public-side material is
lead or galvanized requiring replacement (considered lead). Please visit the City of
Oshkosh Service Line inventory site to determine what the public-side and private-
side materials of the service line are. Use this link,
https://www.oshkoshwi.gov/WaterServiceInventoryViewer.html, or scan the QR
code to the right:
Verification of the private-side water service line materials is required prior to the City
replacing the public-side water service line. Discovery of lead or galvanized considered
lead on the private-side during replacement of the public-side will require the private-
side become lead free within 180 days. If the private-side water service line material is
unknown, please call (920) 232-5336 to schedule an inspection or use the QR code to the
left.
HOUSEHOLD INFORMATION
Property Owner’s Name(s): ____________________________________________________________________
Applicant name, if not property owner: _________________________________________________________
Property Address: _______________________________________________________ ______ _________
___________________________________________________________________________
If not the owner, are you a resident at this address? YES NO
You must be an owner or resident of a property to apply!
Applicant Home Phone: _____________ ________ Applicant Cell Phone: __________________________
Applicant E-mail Address:_____________________________________________________________________
The City will use this e-mail address to communicate important information about the program. Please
check this box if you do not wish to receive information via e-mail:
I:\Engineering\Lead Service Lateral Replacement\2024 Program\Final Documents\Public-Side LSLR Program
Application Form_3-21-25.docx
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Is the property used for a licensed childcare facility or school? (Check one) Yes ____ No ____
Are any residents of the property currently pregnant? (Check one) Yes ____ No ____
List the age of all children living or routinely spending significant time at this address or property:
____________________________________________________________________________________________
Are any residents of the property currently immunocompromised? (Check one) Yes ____ No ____
The City will review the information provided and prioritize the replacement of the public-side water
service line. Replacement of the public-side water service line may take six (6) months or longer,
depending on several factors, including time of year, existing workload, and priority ranking.
The City will provide you with an estimated date for when we will complete the public-side water service
line replacement. Properties at the bottom of the ranking may have the date extended as additional higher-
ranking properties apply. The City will provide instructions on how to obtain a pitcher and filters certified
to remove lead with the estimated completion schedule. Qualified properties may request the City
perform a lead test on the water from their home. Results of the test may result in the City re-evaluating
the ranking of the property.
I attest the above information is correct.
Applicant Signature: __________________________________________________________________________
Date: _______________________________________________________________________
Please call (920) 232-5336 if you need assistance.
RANKING
1. Properties with a leaking or failed public-side or private-side water service line.
2. Properties where owner is replacing the private-side water service line on either a planned or
emergency basis.
3. Properties where Oshkosh Water Utility has determined that replacing a private-side water service
line is in the best interest of health and safety.
4. Properties with licensed childcare facilities and schools.
5. Properties where children under the age of seven or pregnant women reside.
6. Properties with immunocompromised residents.
7. All remaining properties with public-side lead or galvanized requiring replacement water service
lines and non-lead private-side water service lines.