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Water Meter Installation Application

2. Building Permit Number:*
3. Assigned Utility Account Number:
5. Service Address:*
   This address would be provided by the Building Department along with the Building Permit Number
6. Parcel Number:*
8. Account Type:*

   1. Commercial
   2. Residential
   3. Multi Family
   4. Commercial -Irrigation Only
   5. Residential -Irrigation Only
9. Location:*

   1. Inside City Limits
   2. Outside City Limits
   3. Annexed Area
10. Notes:
    Please provide information that may be important
12. Applicant's Full Name/Business Name:*
13. Applicant's Contact Phone:*
15. Billing Address:*
17. I understand that a deposit must be made before this application can be processed*

    1. I understand and accept the charges.
21. Meter Size:*
    -- Select One --5/8" x 3/4" Meter5/8" x 3/4" Meter (with fire suppression)1" Meter1.5" Meter2" Meter - Commercial3" Meter - Commercial6" Meter - Commercial8" Meter - Commercial
22. Installation Process:
    The installation of your meter will usually take two weeks from the time of your meter purchase
24. Initial Cross Connection Survey
    As part of our on-going efforts to ensure the safety of your drinking water, we are required to protect our system against cross connections. As described in the enclosed brochure, cross connections are connections between the drinking water plumbing and a source of contamination. Cross-connections can make our drinking water unsafe. The purpose of this questionnaire is to help determine if you have any special plumbing or activities that pose an increased risk of contamination to our water system. Please fill out the following questionnaire and check the appropriate boxes below:
26. My residence has or will have:*

    Check all that apply

    1. automatic sprinkler/irrigation system
    2. swimming pool
    3. hot tub
    4. livestock watering
    5. fire sprinkler system
    6. private well or secondary water source
    7. solar heating system
    8. radiant floor heating
    9. water treatment system (hard water)
    10. gray water system
    11. water supply to dock or moorage
    12. septic system
    13. NONE OF THE ABOVE
27. My non-residential location has or will have:*

    Check all that apply

    1. agricultural (farms and dairies
    2. beverage bottling plant
    3. car washes
    4. chemical plants
    5. commercial laundry / dry cleaner
    6. reclaimed & potable water provided
    7. film processing facilities
    8. food processing plant
    9. hospital, dental clinics, nursing home
    10. blood plasma center
    11. water treatment plant
    12. laboraries
    13. metal plating industries
    14. mortuaries
    15. petroleum processing & storage
    16. piers and docks
    17. radioactive processing plant
    18. nuclear reactors
    19. survey access denied or restricted
    20. water lift & pumping stations
    21. unapproved auxiliary water supply
    22. NONE OF THE ABOVE
29. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Electronic Signature*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field