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Water/Wastewater Service Request
Applicant Information
Project Name/Owner
Service Address
Must include building/house number and street name. Ex: 123 Electric Ave.
Contact
Phone
Email Address
Request Overview
Type of Service Request (check all that apply)
New
Upgrade
Relocation
Temporary
Other
If Other
Property Use (select one)
Residential
Commercial
Industrial
Existing or New? (select one)
Existing
New Construction
Desired In-Service Date
Water Service Information
Water Service Type (check all that apply)
Domestic
Irrigation
Combined
Fire Line
Fire Line (if applicable)
Requested Meter Size
5/8"
1"
1 1/2"
2"
Other
If Other
Estimated Demand (GPM)
Peak Demand (GPM)
Wastewater Service Information
Wastewater Service Requested?
Yes
No
Certification
I certify that the information provided on this form is accurate to the best of my knowledge.
Date
Submit Request
