Did you know that the City of Portland offers a Leak Adjustment Form? The form can be used to request a lower water bill if your property has experienced a leak. To qualify for the adjustment, you must provide documentation that shows the leak occurred on your property. You can find more information about the form and how to submit it on the City of Portland website.
This basic report will allow you to establish the time it'll take you to complete leak adjustment form, how many pages it's got, and some additional unique specifics of the form.
|Form Name||Leak Adjustment Form|
|Form Length||1 pages|
|Avg. time to fill out||15 sec|
|Other names||leak adjustment form, city of houston water bill adjustment form, texas leak adjustment form, city of houston water|
CITY OF HOUSTON
Public Works and Engineering
Leak Adjustment Request Form
Account No. _____________________________________
Utility Customer Service P.O. Box 4863
Service Address __________________________________
Daytime Phone No. __________________________
A City of Houston ordinance allows for a Leak Adjustment credit because of loss of water through an “excusable defect” in the customer’s water line. An excusable defect is due to a rupture or leakage caused by weather, settlement, corrosion, wear, or accident. Visible leaks such as faucet and hose leaks are ineligible. Credit may be given for
I, _____________________________________, am the Responsible Party for the account at the above service address.
(Give full legal name and/or business identity)
I am asking the City of Houston to reduce the water bills for this account, to the extent allowed by city ordinance because of a leak beginning on (date) ______________ and repaired on (date) _______________. During this period, the following
additional water appliances (washer, dishwasher, spa, etc.) were installed at the service address. State “NONE” if none were added: ______________________________________. The water lost from this leak was not used by anyone.
IN ORDER TO PROCESS YOUR APPLICATION QUICKLY & EFFICIENTLY, PLEASE READ THE FOLLOWING CAREFULLY AND GIVE A COMPLETE AND CLEAR DESCRIPTION OF THE REPAIRS.
Type of leak on customer’s side of meter: _______________________________________________________________
Description of repair:________________________________________________________________________________
Attach documentation of the repair date, address, type of repair, and cost. Acceptable documents include plumber’s statement/bill or a receipt for parts. Businesses with
In all cases the City retains the right to make field verifications before approving leak adjustments. You will be notified by mail generally within 90 days whether your request is approved or denied.
I am familiar with all of the facts stated in this document and they are true and correct. Making false statements on this government record is subject to criminal prosecution under Chapter 37 of the Texas Penal Code. I certify that this application and attached documents contain no false statements.
Print Name: _____________________________________________________ Date: _______________________
Signature of person requesting a leak adjustment: _______________________________________________________
Complete the form and return to Utility Customer Service, Accounting Section, P.O. Box 4863, Houston, Texas
Leak Adjustment Req Form ENG -