2. 

3. 
   

   
   

   Adjustment Request
   
   NEW SOD OR LANDSCAPING

4. City of Tarpon Springs

   Utility Billing Division
   PO Box 5004
   Tarpon Springs, FL 34688-5004
   Phone: (727) 942-5609  Email: ubcts@ctsfl.us

8. *SEWER CHARGES ARE ADJUSTED FOR ACCOUNTS WHICH PAY METERED POTABLE WATER AND HAVE SEWER SERVICE PROVIDED BY THE CITY OF TARPON SPRINGS*

10. WATER CHARGES WILL NOT BE ADJUSTED

12. A new sod of landscape credit is not applicable for customers using well water, effluent water, or other water sources such as ponds and cisterns.

    I am requesting an adjusted sewer charge to establish landscape over a 30 day period.

14. Start Date:*
    Start Date:
15. Stop Date:*
    Stop Date:
17. Date of Application*
    Date of Application

19. I understand the water is used and will not be adjusted. I understand I may not withhold payment during the review and processing of this request. I understand that any credits allowed for this request will appear on my utility bill as an adjustment amount within 60 days.

21. Name*
22. Email Address*
24. Address*
26. City*
27. State*
28. Zip Code*
30. Phone Number*
31. Account #*
33. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field