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Temporary Agricultural Irrigation Water Meter Application

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.

22. Installation Process:
    The installation of your meter will usually take a few days from the time of your meter purchase

    The installation of your meter will usually take a few days from the time of your meter purchase

23. Hook Up Charge:
    $420.56 Includes meter, back flow rentals, & testing.

    $420.56 Includes meter, back flow rentals, & testing.

25. Usage Rate:
    (Jan - Mar): $1,684.22 per million gallons (Apr - Dec): $2,408.00 per million gallons

    (Jan - Mar): $1,684.22 per million gallons (Apr - Dec): $2,408.00 per million gallons

26. Maximum Usage:
    120 Days

    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.

    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