CITY OF MONROE
664 Commercial Street
P.O. Box 486
Monroe, OR 97456
PH. 847-5176/FAX 847-5177
APPLICANT NAME:
PHONE NUMBER: HOME (541) BUSINESS
MAILING ADDRESS:
SERVICE ADDRESS:
DATE SERVICE TO BEGIN:
OWNER NAME:
OWNER ADDRESS:
LEGAL DESCRIPTION: Section Township Range Lot RESIDENTIAL COMMERCIAL INDUSTRIAL
DRIVER’S LICENSE # SOC. SEC. #
PREVIOUS ADDRESS:
RESIDENTIAL RATES: Water Minimum - $10.00 for the first 2,000 gallons
Water Excess - $5.00 per 1,000 gallons or part thereof
Sewer Flat Rate - $28.66
COMMERCIAL: Water Minimum - $25.00 for the first 2,000 gallons
Water Excess - $5.00 per 1,000 gallons or part thereof
Sewer Flat Rate - $28.66
Refundable Deposit Required of $75.00
The city bills in arrears. Payments are due by the 15th of the month. Any bill outstanding on the 16th of the month may be subject to a 1.5% penalty and/or turn off. In the event of a turn off, all fees must be paid plus a $35.00 service charge to restore service.
I have read the above conditions and agree to be the responsible party for payment of charges.
Signature Date