Sewer Meter Application

Name

First Last

Account Number

Service Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone #

Is Service Connection Address The Same As Billing Address?

Yes

Person or Company Requesting Sewer Meter:

Contact Phone #

Meter Size Requested - Select One

Meter Sizes Greater Then 1” Will Be Special Order and Not Kept in Township Inventory

Amount Paid

Signature of Official Accepting Application

Date