Hydrant Meter Application

Today's_Date *

Year

Month

Day

Name *

Company Name

Billing Address *

City *

State *

Zip Code *

E-mail Address *

Telephone Number *

Private or Public *

Public Hydrant

Private Hydrant

Specific location of hydrant *

Authorizing Signature (private hydrant only)

Hydrant meter size required: *

Applicant will be responsible for the security and protection of Portland Water District property. It is the responsiblity of the customer to adapt their application to fit the connections provided on the Hydrant Meter Assemblies.

Winter Hydrant Meter Use

It is the responsiblity of the applicant to protect the hydrant meter and hydrant, including keeping it from freezing. The applicant will be fully liable for any damage to the equipment or infrastructure of the Portland Water District.

Authorizing Signature *

Rules and requirements for hydrant meter use. *

Agree

I have read the rules and requirements for hydrant meter use (link on the left of this form).

Set Date (must be scheduled at least two days in advance) *

Year

Month

Day

Removal Date Request *

Year

Month

Day

Purpose of Use *

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Hydrant Meter Application

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