2. CIty of Port Arthur
   Utility Operations Department
   Application for Excess Water/Sewer Letter
4. I have requested an adjustment because of high water/sewer bills due to 1) high consumption caused by a waterline leak or 2) unexplained high consumption. In either case my consumption has returned to normal levels so that a sewer/water adjustment could be calculated. I have already received an adjustment of $250 which is the maximum amount that the Utilities Operation Department is authorized to credit to my account.
6. I hereby request that Management of the Water Utilities Department credit my account for an excess sewer/water adjustment in the following amounts:
8. Amount for Water
9. Amount for Sewer
11. I agree that I will be responsible for the balance after the total adjustment is credited to my account.
13. I have signed and dated this application and I am returning it with another payment on my account so that the excess adjustment can be forwarded to Management for approval.
15. Signature
16. Date/Time
    Date/Time

    Date/Time
18. Account Name
20. Service Address
22. Account Number
24. Phone Number
26. Additional Approved Adjustment
28. Signature of Responsible Party
29. Date/Time
    Date/Time

    Date/Time
31. Utility Operations Representative
32. Date/Time
    Date/Time

    Date/Time
36. Supervisor Approval
37. Date/Time
    Date/Time

    Date/Time
39. Verified
40. Posted
42. Forwarded to Finance Department
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45. Email address

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