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2. City of Beach Water Turn On/Off
4. First Name*
5. Last Name*
7. Address1*
   House #, street where service is requested
9. Phone No.*
10. E-mail address*
    We will e-mail you to make sure you are the homeowner.
12. Alternate

    If a different person will be meeting with Public Works for turn on or to allow entrance for meter removal please state alternate contact name and phone number.

13. Instructions for Water Services to be turned on

    Note, a person you appoint needs to be available to meet with someone from the Public Works Dept. at the house AND your person needs to be able to go in the house to check for leaks and/or reinstall the water meter.

15. An excerpt from Ordinance 14.015:

    Shutting off water: Charges for. The City shall charge the sum of $25.00, plus the cost of materials, for turning on services to the City Water System for the purpose of repairs or tests on behalf of the owner or consumer.

16. View Water Charges Chapter
    Chapter 14 of Beach Ordinance Book
18. 24 hour advanced notice required.

    Hint: if turn on or off service is requested on a friday, nothing will happen until Monday.

19. Water Services to be turned: *
    -- Select One --ONOFF

    choose one from the drop down menu
20. Date Service Requested
    Date Service Requested

    Date Service Requested

    The Public Works is available 7am-4pm M-F (No weekends please) and will try to work around your requested date and time. But no guarantee. Someone from the PW Dept. will call you to set up a definite date and time with you.

22. Liability Waiver of City of Beach

    By signing below (electronically checking), I'm signifying that I was informed of the turn on fee. Also, if the meter stays in place I am responsible that the heat stays at a suggested minimum of 50 degrees so that the meter does not freeze and break resulting in me paying to replace that meter.

    If you have any questions or other comments please email us at cityofbeach@midstate.net. 

23. Checkbox for Liability Waiver*

    1. electronic signature
24. Date Form Filled*
    Date Form Filled
26. Confirmation Email

    1. Yes

    Check the box below if you would like a confirmation email sent to the email address above after the requested service has been done.
28. For City Use
29. For City Use
31. Comments:
    (meter info: still hooked up, drained but still there, etc.)
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field