2. This form will order an outside watering meter from the Grinnell Water Department. Submit one form per address.

4. There is a $20 charge for use of the meter that will be assessed on your water bill after the meter is returned. Once the meter is returned a sewer credit for the amount of water usage will be added to your water bill. At the current sewer rates, 300 cubic feet (approximately 2250 gallons) of water needs to be used through the meter to cover the $20 charge.

6. Owner Information
8. Name on City Utility Account*
10. Address Requesting Outside Watering Meter*
11. Contact Person (if different from above)
13. Contact Number*
14. Alternate Contact Number
15. E-mail Address
17. Do you need more than one meter for this address?*

    1. No
    2. Yes
18. Total Number Meters Requested*
20. Water department staff will deliver an outside watering meter to the address listed above within 48 hours after this form is submitted.

22. THE CITY’S POLICY IS TO RELEASE METERS ON OR AFTER MAY 1ST TO CUSTOMERS WITH THE UNDERSTANDING THAT THE METER IS TO BE RETURNED TO THE WATER DEPARTMENT BY OCTOBER 1ST OF THE SAME YEAR. THE UNDERSIGNED UNDERSTANDS THAT IF THE WATER METER SHOULD BE FROZEN, DAMAGED, OR STOLEN THE UNDERSIGNED WILL BE RESPONSIBLE FOR THE REPLACEMENT OF THE WATER METER. THE CURRENT COST OF A WATER METER IS $149.50 (SUBJECT TO CHANGE).

24. Electronic Signature of Owner or Owner's Representative*
26. Date*
    Date
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field