Potable Water and Irrigation Usage Charges Adjustment Request Form

Utilities Commission, City of New Smyrna Beach, Florida
Phone (386) 427-1361 | Fax (386) 424-2713 | www.ucnsb.org
Portable Water and Irrigation Charges Adjustment Request
There is a $35 service fee for this request. Upon customer request, UCNSB may adjust potable water and irrigation usage charges if there is appropriate proof that a system leak and subsequent repairs on the customer’s side occurred. Documentation of the leak and repair from a plumber or other service provider is required. UCNSB reserves the right to require additional documentation prior to consideration and is the final authority in the determination of adjustment requests. Usage pattern during the timeframe in which the incident occurred must be abnormally higher than average for an adjustment to be issued. Limit of one adjustment per location per service type (potable water or irrigation) each calendar year. Adjustments must be requested within six (6) months of the incident. Only potable water and irrigation usage charges may be adjusted. No adjustment is made for service base rates. Current credit request fees apply.
Customer Information
First Name:
Last Name:
Account Number:
Service Address:
Zip Code:
Type of Leak:
Potable Water Leak
Irrigation Water Leak
Approximate Date of Leak:
Date of Repair:
Circumstances regarding leak:
Please upload documentation, receipts and pictures here:
*All fields marked with a red asterisk are required
Applicant Signature
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