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Sewer Adjustment Request Form

  1. This form is a request to credit a utility account for sewer charges during a specific event in which water usage failed to flow into the sewer system. This form is not a guarantee that a credit will be applied to your water bill. You will be notified by phone if the request cannot be granted or if additional information is needed. Please continue to pay your utility bill by the due date. Failure to do so may result in penalties and/or interruption in your service. If approved, the adjustment should be reflected on your next utility bill.
  2. Reported Event*
  3. If attaching multiple pages, you must use PDF, TIF, DOC, or PNG formats ONLY.
  4. 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.
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  6. This field is not part of the form submission.