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City of Oldsmar Application for Water/Wastewater Service

2. Date

3. Check one

   1. Commercial
   2. Residential
   3. Irrigation

4. Meter size

6. Legal Description

7. Property Address

9. Owner or Authorized Representative

10. Mailing Address

12. Phone

13. Email

15. 6th Edition (2017) Florida Plumbing Code Applies
    IRRIGATION METERS ONLY: Irrigation meters will be placed next to present meter only. Appointment cannot be made for installation. Homeowner will be responsible for installing systems to meter.

    IRRIGATION METERS ONLY: Irrigation meters will be placed next to present meter only. Appointment cannot be made for installation. Homeowner will be responsible for installing systems to meter.

17. If commercial, complete the following:

19. Name of firm and mailing address:

20. Person responsible for Bill:

22. Email Address:

23. Phone No.

25. Signature

27. Square Foot Bldg

28. This building will be sprinkled:

    1. Yes
    2. No

29. Is there a fire hydrant on this property:

    1. Yes
    2. No

31. Permit No.

32. Permit Fees Due: $

33. Receipt No.

34. Total Amount Rec'd

36. Meter Size

37. Date

38. Work Order No.

39. Security Deposit

41. Water Impact Fee

42. Sewer Impact Fee

43. Water Connection

44. Sewer Connections

46. Meter Installation

48. Number of ERU's

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field