ST0001-CS02071807/18/02 10:09 CITY OF COPPELL 4 972 304 7041
COPPELL
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Date: 1,19
Project Name:
Location of Meter: I/I
Billing Account Name
Billing Address: �
Phone p: (q'I;t 1 91A 7nn I
METER ISSUANCE / WORK ORDER
/ C o mpany/Representative:
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City:
Printed Name:
NO.2eO D01
Account Number:
State: Zip Code:
D.L.#:
Signature:
Domestic Mtr. // Size: Reading Deposit Amt.
t/ r at'on tr. Lf Z" g Size: o� / t Reading Deposit Amt.
Fire Line Mtr. I/ Size: Reading Deposit Amt. T`y
Temporary Mtr, k Beginning Reading Deposit Amt.
TEMPORARY METERS: 51 DEPOSIT REOt►tRED
Applicant shall notify the Utilities Division when they are finisbed with the meter. Cost of any repairs or replacements
necessary shall be billed on the final smWeaent or deducted from the deposit.
Applicant is responsible for winterizing all temporary construction teeters and components to protect them against any damage
due to freezing temperatures.
Customer is allowed to move or relocate a meter after the City has read the meter. Customer must call 972 - 304 -3545 to
schedule a reading. The City is not responsible for any stolen property under any conditions.
The City will deposit the S1,000 upon receipt. The minimum monthly water bill shall be $48.40 for the first 1.000 gallons
used. All water in excess of 1 .000 gallons will be $2.60 per 1,000 gallons. Monthly payment is due by the S" of each mouth.
If payment is not received by this date, tbere will be a penalty of 10% accessed to the total balance.
Water Tap S Sewer Tap $ Meter $ Final Inspection E
Meter Inspection Date:
DDC Inspection Date:
Backflow Device Inspection Date:
Pass:
Pass:
Pass: .
Fail:
Fail:
Fail:
BEFORE FINAL INSPECTION OF THE METER dt SETTING CAN BE COMPLETED, THE BACKFLOW
PREVENTION DEVICE MUST BE TESTED BY A CERTIFIED BACKFLOW PREVENTION TESTER.
Employee Making Inspection:
Inspection Comments:
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White: Water UtUltles Pink: Water Billing
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