HomeMy WebLinkAboutUtilitiesUtility Billing Adjustment Committee Form
In order to qualify...
High use must be due to a leak caused by deteriorated pipes and fittings; not excessive irrigation, left-on hoses,
toilet flappers, etc.
All requests must be submitted within 60 days and include proof of repair.
Water usage must exceed Tier 2 consumption (13 units) and be at least 50% higher than previous billing cycle.
Customers are limited to one billing adjustment at any one service address per 24-month period.
First Name *
Last Name *
Water Service Address:*
Mailing Address (if different from above):
Account Number:*
Phone Number
Email *
The above service address had unusually high water use due to (check all that apply):*
Jim
Dummit
City
San Lu8s Obispo
State / Province / Region
Ca.
Postal / Zip Code
93401
Country
SLO
Street Address
3100 Johnson Ave
Address Line 2
City State / Province / Region
Postal / Zip Code Country
Street Address
Address Line 2
Area code + Telephone Number
ex: myname@example.com
Indoor Plumbing Leak (Toilet, Shower, etc)
Outdoor Plumbing Leak
Service Line Leak
Irrigation Leak
Other CU. Hot water line under residence
Please explain the nature of the problem that has caused the high water usage:*
Please attach documentation that the leak/problem has been fixed. ( Repair receipts, pictures, etc)
Additional documentation (if needed)
Additional documentation (if needed)
Cu. hot water line leak that occurred, while away 4 weeks on vacation.
Plumber replaced copper line failure, serving Bathroom 2.
If explanation is longer that this form allows, please attach a word document outlining your request.
IMG_5482.jpg 351.86KB
Power Plumb. bill.pdf 102.3KB
Power Plumb. bill 1.pdf 200.35KB