Pull Auto Flusher Meter Request

Builder Company Name

Contact Information

Phone Number

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

First Name

Last Name

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.