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Sewer/Pool Adjustment Form

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Request Date:*
Request Date:
Request Date:
Account Number:*
Name:*
Service Address:*
Billing Address:*
Phone Number:*
Email:*
Driver's License*
Upload applicant's driver's license
Date(s) of leak:*
Date(s) of repairs:*
Type of Adjustment:*
1. Sewer Leak
2. Pool Adjustment
I attest that no water went into the sewer.*
1. Yes
2. No
Attach a copy of the parts and/or labor receipt(s).*
I/We acknowledge the above-mentioned repairs were made and understand the policies outlined on this form. If required or requested, I/we understand plumbing/pool repairs may be inspected in order to ensure compliance.*