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2. Property Owner First Name
3. Property Owner Last Name
5. Water Service Account Number
6. Phone Number
8. Tenant (if different):
9. Phone Number
11. Property Address
13. Address2
15. City
16. State
17. Zip
19. Email Address
21. Mailing Address (if different)
23. Address2
25. City
26. State
27. Zip
29. The customer is responsible to immediately stake the location of the proposed reuse meter. Stakes will be available at the Customer Service Department. Allow three (3) weeks (±) for installation of the reclaimed service line and meter once the potable backflow preventer has been installed.

    1. I agree
31. Please do not plant any trees, flowers, sod, etc. until the system is on-line so this does not result in any damaged foliage.

    1. I agree
33. Signature*
    By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
34. Date
36. Please contact our Water Customer Service Division at 321-433-8800 in 2-3 business days to confirm receipt of the form and to discuss payment options.
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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