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2. Temporary Agricultural Irrigation Water Meter Application
6. Site Address:*
   Cross roads if no know address
8. Hydrant Number:
9. Number of Acres Irrigated:*
11. Applicant's Full Name/Business Name:*
12. Applicant's Contact Phone:*
14. Billing Address:*
16. Email address:*
    Please provide your email address as we will send a receipt of payment and any correspondence
18. I understand that a deposit must be made before this application can be processed*

    1. I understand and accept the charges.

    *We will be contacting you to receipt in payment before the meter is connected*
22. Installation Process:
    The installation of your meter will usually take a few days from the time of your meter purchase
23. Hook Up Charge:

    $448.04 Includes meter, back flow rentals, & testing.

25. Usage Rate:

    $2565.00 per million gallons

    $0.0192 per cubic foot

26. Maximum Usage:
    120 Days
28. Important Information - Please Read
    Applicant is responsible for loss or damage to meter or back flow equipment which includes freeze damage. The City does not provide a pressure reducing valve. To discontinue service, contact the City Shop at 360.293.1921. Temporary water use is the first service to be disconnected in the event of an emergency water shortage.
30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field