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2. Resident Information
4. First Name
5. Last Name
7. Phone Number
8. Email Address
10. Utility Customer Information
12. Address
14. City
15. State
16. Zip Code
18. Type of Service at Property*

    1. Indoor/household use only (non-irrigation)
    2. Irrigation (only for landscaping/watering)
    3. Both (Indoor use and irrigation)
    4. Private well
    5. Other
20. Water Service Line Material*

    1. Copper
    2. Galvanized (magnetic)
    3. Plastic (white or colored)
    4. Lead (not magnetic, easily scratched)
    5. Unknown/Cannot determine

    
    Unsure how to check?

    Identifying Service Line Material
    Two minute video: How to determine your water service material

22. Upload a photo
24. Additional Information
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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