Form Center

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:

20. Mailing Address

22. Phone No.

23. Person responsible for Bill:

24. Email Address:

26. Signature

28. Square Foot Bldg

29. This building will be sprinkled:

    1. Yes
    2. No

30. Is there a fire hydrant on this property:

    1. Yes
    2. No

34. TO BE COMPLETED BY THE CITY

    TO BE COMPLETED BY THE CITY

36. Permit No.

37. Permit Fees Due: $

38. Receipt No.

39. Total Amount Rec'd

41. Meter Size

42. Date

43. Work Order No.

44. Security Deposit

46. Water Impact Fee

47. Sewer Impact Fee

48. Water Connection

49. Sewer Connections

51. Meter Installation

53. Number of ERU's

Leave This Blank:


54. Print Only

* indicates a required field