Peninsulas-WO 980624CITY OF COPPELL ~
WAT4ER UTILITIES
WATER ISOLATION REQUEST AND/OR METER RELOCATION
The following information must be provided in order to allow
isolation of any part of the City of Coppell Water System.
This form must be completed and submitted to the Utilities
Division for processing twenty four (24) hours prior to the
date the, isolation is requested.
Date: GlO'IgC! Time: +i 5~
Project: I~
Contractor: PO_~(~ ~1~
Contractors Representative: C~I~ ~Of~
Print Name: ~'~ ~0~
Phone # ~-~C
Area Affected(Street,Block No.):
D~T~ R~U~$T ~S NEEDED:
Time Off:
Time On:
Water Main Size:
Water Service:
Inches
Inches
If water customers of the system will be affected, contractor
shall provide a list of each of those business or residential
structures affected.
* Note.' The City of Coppell Utilities Division shall perform
al~ w. ater line shut-downs. Contractors are not
~.~i~ ~ ~n any valv.s in t~..y.t~.
Signed:
~ %/~actprs Representative , Date
Print Na~e:
,0R~'"~-=~-~-~'R R--. OCA= 0. o= ,~.. mo. ~
Date Amount of Payment Initials
* (Attach work order for relocation only)
(~SOLATION)
The City With A Beeutlful Future
P.O. Box 478
Coppell, Texas 75019
Name
Service Address
Date ~/,~.~c//' Cash Check No.
WATER TAP / METER INSP. FEE
SEWER TAP INSP. FEE
UTILITY FINAL INSP. FEE
SECURITY DEPOSITS-WATER
WATER / SEWER SERVICE SALES
WATER METER SALE8 R~tENUE
WATER TAP FEE
SEWER TAP FEE
CUSTOMER SERVICE INSPECTION
BACKFLOW DEVICE REGISTRATION
BACKFLOW DEVICE TESTED REGISTRATION
METIER TEST FEE
17 9 2 ~ /_ JOTAL /~ ~-~
Received By