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Water Shut-off Request

2. Water Shut-off Request
   48 hour notice is REQUIRED for water shut-off at the curb stop. If this is an emergency please contact the Department of Public Works at (414) 847-2650.

   48 hour notice is REQUIRED for water shut-off at the curb stop. If this is an emergency please contact the Department of Public Works at (414) 847-2650.

4. 

5. Today's date*
   Today's date

6. Request Shut-off Time
   Request Shut-off Time

   Request Shut-off Time

   Time is not guaranteed and must be coordinated with Utility Foreman.

8. Has plumbing permit application been filed?*
   -- Select One --yesno

10. Property address*

11. City*

13. First Name*

    Name of requesting party

14. Last Name*

16. Phone Number*

18. Plumbing contractor (if applicable)

20. Plumber's telephone number

22. Acknowledge Fee*

    1. I acknowledge and accept $40.00 fee.

    Per the Wisconsin Public Service Commission, a re-connection fee shall apply. A $40.00 fee will be added to the property's next issued utility bill.

24. Staff Use Only

    Employee initials if submitted by staff.

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field