Utility Service Application

City of Goodyear Sewer Appeal Request for Sewer Fee Adjustment

NOTE: The information provided on this form will be used to adjust your sewer fee for water consumption that is not disposed of through the City's wastewater collection system. Sewer Fees are based on your average water consumption for the winter months billed in January, February, and March of this year. If you believe the water consumption for these three months is a misrepresentation of your water that is disposed of through the City's wastewater collection system, please complete the following information. Find sewer appeal process information at our Sewer Appeal Q & A.

1. Have you had a home irrigation check in the past 12 months?

Yes No

2. Did you submit a request for sewer fee adjustment last year?

Yes No

3. Customer Name

4. Service Address

5. City

6. State

7. Zip Code

8. Home Phone

9. Cell Phone (optional)

10. Email Address

11. Account Number

12. Any changes on water usage from last year?

Yes No

13. Number of Occupants in Household

14. Winter Lawn square footage (Length X Width=Square Footage) Please enter number ONLY for the total square footage. Enter 0 if none.

15. Garden square footage (Length X Width=Square Footage) Please enter number ONLY for the total square footage. Enter 0 if none.

16. Total Number of Trees Please enter numbers ONLY. Enter 0 if none.

17. Total Number of Shrubs Please enter numbers ONLY. Enter 0 if none.

18. Total Square Footage of Pool, Spa, Fountains, and Ponds (Length X Width=Square Footage) Please enter number ONLY for the total square footage. Enter 0 if none.

19. Were any leaks detected and repaired during the months of January, February or March?

Yes No

20. Estimated leakage in gallons per month Please enter numbers ONLY. Enter 0 if none.

21. Was your pool filled and/or repaired during the months of January, February or March?

Yes No

22. Did you have pool repairs during the months of January, February or March?

Yes No

23. If your pool was filled was it the initial fill?

Yes No

24. Number of gallons added to pool due to a repair or initial fill Please enter numbers ONLY. Enter 0 if none.

25. Total number of Livestock at property Please enter numbers ONLY. Enter 0 if none.
* Definition for appeal purposes is a horse or a 4 legged food producing animal.
* Household pets do not qualify as livestock.

26. Additional Comments

NOTICE:

* Copies of actual receipts for materials purchased and/or work done MUST be submitted.

* Appeal will be denied if no documentation is provided.

* Fax receipts to: 623-932-3003 or email them to gyutilities@goodyearaz.gov

* If you are unable to fax or email copies of the required documentation to process your appeal they can be dropped off or mailed to:

City of Goodyear
Attention Utilities-Sewer Appeal
190 N Litchfield Rd.
Goodyear, AZ 85338

By submitting this form I agree that the above information is accurate to the best of my knowledge. I understand that the given values are subject to verification and if there is an error, I will be charged for any incorrect allowance not previously billed. Any allowances, based on the information provided will be reflected in future bills. Please call the Finance Department at 623-882-7887 with questions.