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2. Account Holders Name *
3. Account Number
5. Service Address*
6. Email*
8. Approx Date of Fill*
   Approx Date of Fill
   Can be turned in before or after filling.
9. Approx. Gallons*

   1. Less than 10,000 gallons
   2. 10,000 - 20,000 gallons
   3. 20,000 - 30,000 gallons
   4. 40,000 + gallons
   5. Unknown
10. Acknowledgment statement *

    1. Yes, I understand the below statement.

    The City does not provide a discounted rate for filling a pool. However, if your sewer is affected you may be eligible for an adjustment. Turning in this form does NOT guarantee adjustment. Most residential customers are on winter sewer average and thereby NOT affected by filling a pool. Each account will be reviewed with the submission of this notification. To qualify for adjustment customers must sign up for the water portal at www.granbury.org/myusage
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12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

* indicates a required field