Form Center

2. Contact Information
4. Property Owner Name*
6. Mailing Address*
8. City*
9. State*
10. Zip Code*
12. Phone (Home)*
13. Phone (Cell)*
15. Phone (Work)*
16. Email Address*
18. Property Information
20. Service Address*
22. Existing Water Meter Service Size (Inches)*

    (Inches)

23. Requested Water Meter Service Size (Inches)*

    (Inches)

25. Acknowledgement

    I hereby request Carmichael Water District to change out my existing water meter and replace it with the size listed above. I understand and agree to the following information regarding rates and fees: my billing rate will be adjusted on the next complete billing period following the completion of the work by District staff; the District will not prorate the billing/rates between billing periods; the District charges a service fee for this process in the amount set forth in the District's Fiscal Year Fee Schedule; any future requests for a change in the meter size will require me to pay all costs associated with such change, as listed in the Fiscal Year Fee Schedule.

    I further understand that my request to change the meter size may affect water flow and water pressure to all connections on the property beyond the meter, i.e., house, fire sprinkler system, property, and irrigation systems. Carmichael Water District is not responsible for the possible water flow and pressure loss/increase, damage to the inside or outside of the property, or any other damages associated with this request.

    By signing this form I agree to the fullest extent permitted by law, that I shall indemnify and hold harmless and immediately defend Carmichael Water District, its directors, officers, and employees from any and all damage that may occur with this request.

    I agree to all the conditions stated above.

27. Confirm and Authorize
29. Owner Name*
31. Confirm and Authorize*

    1. By selecting this box, I confirm that all information provided is true and accurate and I authorize this request.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field