Office of the TELEPHONE: (508) 841-8506
Dept. of Public Works watersewer@shrewsburyma.gov
TOWN OF SHREWSBURY
Richard D. Carney Municipal Office Building
100 Maple Avenue
Shrewsbury, Massachusetts 01545-5338
BILLING ADJUSTMENT REQUEST/APPROVAL FORM
Location / Service Address:___________________________________________________
Owner/Requestor Name: _____________________________________________________
Owner/Request Contact Phone#:_______________________________________________
Owner/Request Contact Email:________________________________________________
Date of Initial Request:______________________________________________________
Reason for Adjustment:
□ FLUSHING
□ OTHER:
________________________________________________________________________
________________________________________________________________________
*FOR POOL FILLING SEWER ADJUSTMENTS*
Please attach/provide supporting documentation from the vendor, such as
receipt/invoice, showing reason for adjustment.
Pool Size (Gallons): _____________________
Pool Size (Dimensions): __________________
DATE(S) OF FILL: ______________________
Please check one:
□ NEW INSTALL
□ REFILL DUE TO DAMAGE
Amount / (Gallons) Requested:___________________________________________________
No. 2019 - ___
