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Utility - Fire Hydrant Meter Application

2. Date Meter is Needed*
   Date Meter is Needed Start Date

   —

   Date Meter is Needed End Date
4. Business Name*
6. Contact First Name*
7. Contact Last Name*
9. Service Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Fax Number
18. Email Address*
22. Is the mailing address different than the service address?*

    1. Yes

    1. No
24. Mailing Address
26. City
27. State
28. Zip Code
32. Fire Hydrant Meter Agreement
    I understand that there is a deposit required for the use of the Fire Hydrant meters: The deposit for the 1” or smaller meter is $1000.00. The deposit for the 3” meter is $2000.00. This deposit must be paid and the application must be filled out and turned into the Administrative office before the meter will be available for use. I understand I will receive a monthly bill charging for any water used and a monthly meter fee, based on the size of the meter.
34. 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.
36. Electronic Signature*
    I have read and agree with the terms regarding the use of the fire hydrant meter.
37. Date
    Date
41. When finished using the meter, it is your responsibility to contact the the Utility Billing Department to schedule an appointment to have the meter removed. The Water Department will inspect the meter and record the final reading. If the meter is returned in the same condition as when it was issued, you will receive your full deposit refunded in about two weeks; however, if the meter is not returned in the same condition due to misuse, the deposit will be used to make the repairs, and the remainder if any, will be refunded to you in about two weeks. If the meter is not returned, we will keep the entire deposit, and may pursue legal action. (Ord. 1040.04.j)
45. Deposit
    Please contact the City of Monroe at 513-539-7374 extension 1000 after submitting your application to pay the rental deposit.
49. The below section is for office use only
53. Meter Number
54. Beginning Read
55. Ending Read
57. Meter condition when returned:
    Excellent = Full Refund / Fair = Partial Refund / Not Returned = No Refund
59. Work Order Completed By
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field