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Wastewater

Sanitary Sewer Charge Appeal Summary

The Sanitary Sewer Charge Appeal is a supplementary form that allows companies to show where their water is being discharged.

* Company Name:
* Site Address:
* City:
* Postal Code:
* Contact Person:
* Telephone:
* Email Address:
* Water & Sewer Billing Account Number:

* Study Period: From
To

* Source

Source Description Units (M³)

Regional Distribution System:
Private Wells/Reservoirs:
Rain/Storm Water:
Other (Specify):

Total Sources:

* Diversion (Non-Sanitary)
* Cooling Water & Non-Contact Cooling Water do not quality as a diversion component *

Source Description Units (M³)

Products:
Evaporation:
Irrigation:
Recreation:
Other (Specify):

Total Diversions:

Sanitary Contribution
(Total Sources - Total Diversions):

Percent Sanitary Contribution
Sanitary Contribution / Total Sources * 100:
%

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Revised: Tuesday May 24 2011

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Wastewater

Sanitary Sewer Charge Appeal Summary

* Source

* Diversion (Non-Sanitary) * Cooling Water & Non-Contact Cooling Water do not quality as a diversion component *

* Diversion (Non-Sanitary)
* Cooling Water & Non-Contact Cooling Water do not quality as a diversion component *