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2. 
4. Sewer Bill Adjustment Request
   Please be advised that all requests are subject the the approval of the Public Works Director, and may take several weeks to be reviewed and applied, if approved. Only one request can be approved annually from the last.
6. Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Email Address
15. Phone Number*
16. Fax Number
18. Description*
20. Date Discovered*
    Date Discovered
21. Where was the Leak Located:*

    1. Outside of Home
    2. Inside of Home
22. Was the Leak Repaired:*

    1. Yes
    2. No
23. Please attach any pertinent documents.
25. Who made the repairs?
26. Date of Repair
    Date of Repair
28. 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.
30. E-Signature*
31. Date*
    Date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field