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0q <br />City of <br />Peqpt <br />Lakes— <br />Outside Water Meter Payment Plan <br />Date <br />Account # <br />Account Name <br />Contact Phone Number <br />Property Address <br />Total Amount of Sales $ <br />Number of Payment Periods <br />Agreement <br />( 6 months MAX allowed) <br />The total amount of sales divided by the number of payment periods listed <br />above will be added to my monthly water /sewer utility bill starting on next <br />month's bill. <br />As owner of the property, I am responsible for having a plumber install the <br />meter and I am responsible for all expenses and costs incurred by the <br />plumber. <br />Failure to follow the above agreement shall be cause to have the meter <br />removed from the premises and the water disconnected. The water would not <br />be reconnected until the account balance has been brought current. <br />By signing this form, I as property owner, agree to the above agreement. <br />Property Owner Signature <br />Date <br />