Get Sample Water Leak Adjustment Letter

Org www. ilwacowashington.com Water Leak Billing Adjustment Request Form I am requesting the City of Ilwaco to reduce the water bill for this account to the extent allowed by city ordinance because of a leak beginning on date and repaired on date. 120 First Avenue North PO Box 548 Ilwaco WA 98624 Phone 360. 642. 3145 Fax 360. 642. 3155 Ilwacoadmin willapabay. I the undersigned certify that the water lost from this leak was not used by anyone. Name Account No Mailing Address Service Address Phone Type of leak on customer s side of meter Please attach documents of repairs made and write a brief description of repairs made Signature Date // Please return signed and completed form to City of Ilwaco PO Box 548 Ilwaco WA 98624 FOR CITY USE ONLY Calculation of Water Leak Allowance A. Meter reading immediately prior to leak cu ft C. Metered water during the leak period 2 1 D. Number of meter reading cycles in application Average of 3 years of consumption prior to the leak Meter cycle Reading Date E* F* G* H. I. J* K. L* M. Reading Total cu ft prior periods Average prior periods cu ft. E/18 Periods in this claim from D above Average over claim periods F X G Average bill 31. 60 H 500 X G X 0. 0172 Metered during leak from C. above Metered overage charge J 500 X G X 0. 0172 if 0 Billing reduction K 3xI if 0 New bill for period of leak K L Consumption. I the undersigned certify that the water lost from this leak was not used by anyone. Name Account No Mailing Address Service Address Phone Type of leak on customer s side of meter Please attach documents of repairs made and write a brief description of repairs made Signature Date // Please return signed and completed form to City of Ilwaco PO Box 548 Ilwaco WA 98624 FOR CITY USE ONLY Calculation of Water Leak Allowance A. Meter reading immediately prior to leak cu ft C. Metered water during the leak period 2 1 D. Number of meter reading cycles in application Average of 3 years of consumption prior to the leak Meter cycle Reading Date E* F* G* H. Meter reading immediately prior to leak cu ft C. Metered water during the leak period 2 1 D. Number of meter reading cycles in application Average of 3 years of consumption prior to the leak Meter cycle Reading Date E* F* G* H. I. J* K. L* M. Reading Total cu ft prior periods Average prior periods cu ft. E/18 Periods in this claim from D above Average over claim periods F X G Average bill 31. I. J* K. L* M. Reading Total cu ft prior periods Average prior periods cu ft. E/18 Periods in this claim from D above Average over claim periods F X G Average bill 31. 60 H 500 X G X 0. 0172 Metered during leak from C. above Metered overage charge J 500 X G X 0. 0172 if 0 Billing reduction K 3xI if 0 New bill for period of leak K L Consumption. I the undersigned certify that the water lost from this leak was not used by anyone. Name Account No Mailing Address Service Address Phone Type of leak on customer s side of meter Please attach documents of repairs made and write a brief description of repairs made Signature Date // Please return signed and completed form to City of Ilwaco PO Box 548 Ilwaco WA 98624 FOR CITY USE ONLY Calculation of Water Leak Allowance A. Meter reading immediately prior to leak cu ft C. Metered water during the leak period 2 1 D. Number of meter reading cycles in application Average of 3 years of consumption prior to the leak Meter cycle Reading Date E* F* G* H. I. J* K. L* M. Reading Total cu ft prior periods Average prior periods cu ft. E/18 Periods in this claim from D above Average over claim periods F X G Average bill 31.