Sewer User Fee Adjustment for Water Leaks Application Form
Resident application form detailing the leak and repairs made at the property.
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Town of View Royal Sewer User Fee Adjustment for Water Leaks Application Form
APPLICANTS NAME: Sharon + Peter Bishop ACCT NO.: 105919 MAILING ADDRESS: 561 View Royal Avenue POSTAL CODE: V9B 1B9 PROPERTY ADDRESS: If different: —
TELEPHONE: — CELL: — FAX: — EMAIL: —
Cause of leak: on our property Repair outside tap line before house. (done by plumber) / on our property Repair taps & line from house to wharf. (done by owner) Date leak discovered: after arrival of water bills Date repaired: Jan 29 2014 & Jan 2015 Repairs done by: NB Plumbing Ltd and owner
- Receipts attached, OR
- Copy of CRD Water bill showing a leak adjustment for consumption period
PLEASE NOTE: YOUR ACCOUNT WILL BE REVIEWED. IF AN ADJUSTMENT IS WARRANTED IT WILL BE CALCULATED BELOW AND REDUCED BY A $25.00 ADMINISTRATION FEE.
SIGNED: St Bishop DATE: April 22, 2016
Personal information collected on this form is collected for the purpose of processing this application and for administration and verification. The personal information is collected under the authority of the Local Government Act and TOVR bylaws. If you have any questions about this collection, contact the Town by phone 250-479-6800, or Town Hall at 45 View Royal Avenue. Personal information or business information submitted on this form is not considered to be supplied in confidence.
This section is for TOVR use only
Type of Leak:
- Non-Sewer Affected Leak
- Sewer Affected Leak
Original Sewer Bill Amount ____________________
Administration Fee $ 25.00 Customer’s 3 Year Historical Average Consumption $ ____________________ (average m3) (average m3 at current year $/m3)
Amount of Amended Sewer User Fee: $ ____________________ Adjustment or Refund to be applied to account: $ ____________________
Refund / Invoicing Approved by ____________________ (Director of Finance) Date: ____________________
