Leak Adjustment Request Form
LEAK ADJUSTMENT GRANTED: Yes: ______ No: ______ APPLICATION NUMBER: _________
DATE OF NOTIFICATION TO CUSTOMER: ____________________________
ADDITIONAL INFO: ________________________________________________________________________________
Taken By (Initials): ___________
Date Received: ____________________________
The last averaged water meter reads show a significant increase in your water usage that will result in an increase in your sewer charges and may result in unauthorized use fees. Commercial and Industrial users, with a designated irrigation meter, are billed on an averaged metered water usage over a 12 month period. Metered users with no designated irrigation meter are billed using the averaged metered reads from the months of January, February, and December.
This Leak Adjustment Request Form is being submitted by the customer to request relief from an abnormally high sewer bill as a result of a leak on the customer’s side of the point of service. To submit a Leak Adjustment request complete the following information and attach the required documentation. Failure to provide all the required information and/or documentation will result in no Leak Adjustment.
Account Number: Name on Account:
Day Phone Number: Type of Leak: Inside LeakOutside Leak
Date Leake Occured: Date Leak Repaired:
Brief Description of Leak:
Mail to: Kootenai-Ponderay Sewer DistrictP.O. Box 562Kootenai, Idaho 83840
Drop off:Our office is located at 511 Whiskey Jack Road.
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Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Leak Adjustment Request Form
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