2011_0513Date:
Project Name:
Location of Meter: _
Billing Account Name:
Billing Address:
Phone #:
Printed Name:
T H a - C 1 T Y - O F
COPPELL
r e
E d b 4
METER ISSUANCE / WORK ORDER
City:
Account Number.
l r
State: Zip Code:
D.L. #:
Signature: _ i
Domestic Mir. # �D -lam (� 5<� Size: Reading 0 Deposit Amt
Domestic Mtr. #
Irrigation Mtr. #
Irrigation Mtr. #
Fire Line Mtr. #
Fire Line Mtr. #
Temporary Mtr. #
Size:
Size:
Size:
Size:
Size:
Reading
Reading
Reading
Reading
Reading
Beginning Reading
Deposit Amt
Deposit Amt
Deposit Amt
Deposit Amt
Deposit Amt
Deposit Amt
TEMPORARY METERS: $1.000 DEPOSIT REQUIRED
Applicant shall return the meter to 816 S. Coppell Road when completed with project Cost of any repairs or
replacements necessary shall be billed on the final statement or deducted from the deposit
Applicant is responsible for winterizing all temporary construction meters and components to protect them against any
damage due to freezing temperatures.
Customer is not allowed to move or relocate a meter to different jobs/projects. Only yellow City Fire Hydrants may be
used. Customer must call 972 -462 -5150 to report a reading. The City is not responsible for any stolen property under
any conditions.
The City will deposit the $1,000 upon receipt The current, minimum monthly water bill shall be $48.40, which
includes the first 1,000 gallons used. All water in excess of 1,000 gallons will be $2 -60 per 1,000 gallons. (Minimum
charges are subject to change.) Monthly payment is due by the 5t' of each month. If payment is not received by this
date, there will be a penalty of 100/6 accessed to the total balance.
Water Tap $ Sewer Tap $ Meter $ Final Inspection $