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This form is only applicable to leaks that have been determined to be an "excusable defect," per the City's Code of Ordinances.
"As used in this section, the term “excusable defect” shall mean a rupture or leakage of the customer’s underground water lines from the meter to the foundation and/or under the foundation as may be caused by freezing weather, settlement, corrosion, wear or accident. The term does not include or apply to defective or out-of-repair faucets (inside or outside), internal wall plumbing, sprinkler systems, sprinkler heads, sprinkler lines, sprinkler solenoids, swimming pools, auto-fill pool equipment, toilets, toilet flappers and any outdoor fixture/accessory such as an outdoor kitchen." - City of Melissa, Ordinance No. #20-04
Any residential or commercial customer of the City may request an adjustment of any water bill from the City for water usage because of a loss of water due to damage or an identified leak that has been repaired. An application for adjustment must be submitted within thirty (30) days of the repair of the leak. The City will only make an adjustment to the most recent bill affected by the repaired leak; multi-month adjustments will not be made.
Numbers only, no dashes.
Attach receipt of repair to application. If leak was fixed by the customer, please provide receipt of materials purchased for repair.
Please include a picture of the leak before the repair, if possible.
Please include a picture of the leak after the repair, if possible.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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