Leak Adjustment Request Form

Single Family, Duplexes With Single Meters, and Multi-Family Utility Bill Adjustment Application

Resolution 949 of The City Council of the City of Lynden , Washington, Provision 1

Each property owner ("Account Owner") receiving water utility service from the city has a utility account with the city. Each account owner shall be eligible for one and only one account adjustment as a result of a water leak per ten (10) year period per account. Once an account owner has received an adjustment for a water leak, the account owner shall be ineligible for any future adjustments until the ten (10) years have lapsed, unless there is a change in property ownership.

Provision 2, Adjustment Eligibility Criteria

To be Eligible for a one-time water utility account adjustment due to a water leak, per the terms in Provision 1 of Resolution 949, above, the following criteria must be satisfies:

A. The leak(s) must be behind the water meter on the consumer's side of the service connection to buildings classified as either single family, duplexs with separate meters, duplex with shared meter, or multi-family; and

B. Required repairs must be completed within ten (10) days of the date the account owner occupant was notified by the City, or otherwise knew or should have known of the leak. Failure to complete repairs in a timely manner will result in forfeiture of any opportunity for a utility bill adjustment; and

C. The leak(s) must not have been a result of intentional use or waste, vandalism, or theft; regardless of whether or not the property owner or occupant was aware of the leak(s).

Phone Number

Account Number

Is the service address the same as the mailing address?

Yes

Adjustment Eligibility Criteria Information:

1) Please indicate where the leak occurred on this service location and the date the property owner or occupant was notified of a water leak on the consumer's side of the property:

2) Indicate what repairs were completed to fix the water leak on the property. Please include any proof such as receipts that verify that the water leak has been repaired:

Upload File(s)

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Note: Failure to repair the leak within ten (10) days of notification by the city of Lynden will result in forfeiture of any opportunity for a utility bill adjustment.

3) Please include any other information regarding the leak and your utility bill:

Property Owner Responsibility:

For the billing period in which a one-time adjustment is obtained, the property owner is responsible for the payment of the entire estimated non-leak dollar amount. However, they will not be responsible for payment of the estiamted dollar amount due to the water leak. Any leak adjustment will apply to one billing cycle only.

Property Owner Signature

First Name

Last Name

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