DevSvcs-THP-2019.01.09
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Innovative - Responsive - Professional
Water Meter Pull or
Disconnect Request
Public Works Department
When completed, please submit this request to Public Works at City Hall for review.
TO BE COMPLETED BY APPLICANT
Today's date:
Service address:
Date on which the meter is requested to be pulled or disconnected:
Demolition permit number:
Building permit number:
Is this a single family demo/rebuild? (rebuilding only one new single family on the same lot)
Yes No
Is this property part of a current or future short plat or lot line adjustment?
Yes
No
Is the building currently vacant?
Yes No
Property owner name(s):
Billing address: (line 1)
Billing address: (line 2)
Owner phone number:
Request authorized by:
Printed name:
Signature:
TO BE COMPLETED BY CITY STAFF
Meter to be pulled on or after this date:
(fee for pull = $70 plus estimated final
bill amount)
WATER IS NOT AVAILABLE EXCEPT BY HYDRANT METER OR WATER TRUCK
Meter to be disconnected on or after this date:
(fee for disconnect = $30, applied to the
account)
WATER IS AVAILABLE, CUSTOMER BILLED BASE FEE PLUS
CONSUMPTION
Public Works approval:
Date submitted to Utility Billing:
Notified Public Works that utility bill is paid.
UB Customer #
UB Reference #
