Fillable City of Lebanon Department of Public Works 193 (City of Lebanon)

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City of Lebanon Department of Public Works 193 (City of Lebanon)

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The City of Lebanon Department of Public Works 193 (City of Lebanon) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Lebanon

BROWSE CITY OF LEBANON (NH) FORMS

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Fill in all blanks, attach additional paperwork as necessary. Any request for abatement must be
filed in writing to the Department of Public Works within 30 days of the billing period. The filing of
this form does not guarantee that your abatement will be granted or relieve the applicant of the
responsibility to pay the water or sewer usage bill in full by the due date specified. Further
documentation may be required.
City of Lebanon
Department of Public Works
193 Dartmouth College Highway
Lebanon, NH 03766
(603) 448-3112
Application for Water & Sewer Bill Abatement
Instructions: Account & Property Information:
Service Street Address Acct Number Bill Number
Last Name or Business Name First Name or Business Contact
Contact Phone Contact Email
Date of Contested Bill Amount owed on Contested Bill
Reason for Abatement Request:
Leaking Toilet
Household Plumbing Leak
Outdoor Water Usage (power washer, hose, pool)
Building Unoccupied
Faulty Water Heater
Other:
Monthly Payment Plan Requested
Please provide explanation describing your request for abatement. Attach additional sheets,
if necessary.
Statement of Financial Hardship (Water abatements can only be made due to financial
hardship and inability to pay.). Attach additional documentation to support request.
Signature Printed Name Date
Lebanon City Code Chapter 136 SEWER Service, Article X, §136-80 Abatement
For good cause shown, the City Manager may abate any such fees and assessments made
herein. Any person aggrieved by the neglect or refusal of the City Manager to grant an
abatement may petition the City Council for relief at any time within 30 days after notice of
decision by the City Manager.
Lebanon City Code Chapter 182 WATER Service, Article V, §182-33 Abatement
For good cause shown, the City Manager may abate any bill and/or fees charged herein. The
Manager, or his or her designated agent, will review in private session with the person
requesting abatement that person's need for abatement. The Manager may abate any bill
and/or fees by a decision in writing because of financial hardship and inability to pay or may
set up an installment payment schedule. In the event of a default in the installment
payment schedule, water service may be terminated upon the terms and conditions as
provided in this chapter. In the event that the consumer pays fees in excess of the fees
required by the Code of the City of Lebanon, and abatement is made, the city shall refund
such excess fees together with interest of 6%.
For Official Use Only
____Approved ____Denied Explanation:________________________
___________________________________________________________________
City Manager:______________________________ Date:____________________
Principal Abated_______ Interest Abated ________ Amount Still Owed___________
Payment Plan Amount Owed Per Month_____________________________________
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City of Lebanon Department of Public Works 193 (City of Lebanon)

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Completed 3 August 2020

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