Section 1 of 1 in this document
Pull Auto Flusher Meter Request
Builder Company Name
Builder Billing Address
Street Address
City
State
Zip
Contact Information
Name
First Name
Last Name
Phone Number
Email
Full Service Address
Street Address
City
State
Zip
Subdivision
Meter Serial #
Phase #
Plan #
Please Confirm the Following:
Auto flusher is clearly marked.
Meter box and lid are visible and accessible.
Meter service has water.
Current Flushing Schedule
Number of Cycles
Time Per Cycle
Days Per Week
Time of Day
Sign Here
Sign Here
First Name
Last Name
Email
Choose how to sign
Draw
Type
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
Meters are only to be removed by Manatee County staff after receiving the approved release.
Deposit refunds will apply to the final bill with any residual balance being sent to the customer after confirmation of the meter being pulled.
disregard this