Fillable LEAK ADJUSTMENT REQUEST/ POLICY (City of La Grande, Oregon)

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LEAK ADJUSTMENT REQUEST/ POLICY (City of La Grande, Oregon)

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THE HUB OF NORTHEASTERN OREGON
LEAK ADJUSTMENT REQUEST/ POLICY
POLICY #2005-15
EFFECTIVE 7-1-05
The City of La Grande offers a leak adjustment for an account once the leak has been repaired. Per City
Policy, the City can adjust no more than the last two (2) billing months for water charges and no more
than the last four (4) billing months for sewer charges on commercial accounts. In the case of flat sewer
charges, there would be no adjustment. Leak adjustments are given based on past usage for the same time
period as leak. A leak adjustment will only be considered AFTER proof of repair (plumber’s bill, part
receipts, etc.) is submitted along with completed leak adjustment request. Customer is allowed ONE leak
adjustment per calendar year. *** YOU MUST ATTACH PROOF OF REPAIR***
Name_________________________________________ Date_____________________
Service Address _________________________________ Phone ___________________
Owner _____________________________ Renter ______________________________
Name Name
Date leak repaired ______________________________
Description of leak and how repaired ____________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
By signing this form, I acknowledge that I have read and understand the above Leak Adjustment
Policy.
Customer Signature ________________________________________________________
************************************************************************
Office Use only: Received in office ___________ Approved ___________ Declined ____________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
PO Box 670 * 1000 Adams Avenue * La Grande, Oregon * 97850 * (541) 962-1313 * Fax( 541) 962-1322
www.cityoflagrande.org
CITY OF
LA GRANDE
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LEAK ADJUSTMENT REQUEST POLICY (City of La Grande, Oregon)

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Completed 2 June 2021

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