Water Service Line Self Reporting Progam

2. Last Name, First Name (Should be Utility Account Holder)*
3. Email Address*
5. Service Address*
7. Account Number (Optional)
8. Phone Number*
10. Service Line Material*
    -- Select One --Plastic/PVCCopperGalvanized Steel (Magnet will Adhere)Lead
11. Magnet Sticks to Pipe?*

    1. Yes
    2. No
13. Photo of Service Line (Highly Recommended)

    Please submit a photo of the service line that leads from the floor, wall, or ceiling, to your water meter. 

Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field