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Water Meter Replacement Form

Property Information:

Roll Number:

Account Number:

Existing Owner's Name:

Property Address:

Contact Person:

Telephone:

Existing Meter Information - Serial Number:

Last Reading:

Last Reading Date:

Usage Since Previous Reading:

Reason for Replacement:

Outdated Remote Reader

Internal Register Failure

Damaged/Cracked Case

Other

This meter is supplied by the Township of Georgian Bluffs to replace the current meter which is no longer operating correctly. By accepting this meter I agree that this replacement meter will be installed promptly, that I will contact the Township of Georgian Bluffs Building Department to arrange for it to be inspected within two (2) weeks of the date of pick-up, and that the meter that is being replaced will not become damaged further and will be returned to the Plumbing Inspector upon inspection. If any of these conditions are not met, the Township may deposit my payment of $525.00 with $350.00 being applied against the cost of the new water meter, $75.00 for the permit application (inspection) and the remaining $100.00 as a deposit until the original meter is returned.

Signature:

Clear

Date:

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