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Sewer Appeal Request Form

Please correct the field(s) marked in red below:

City of Goodyear Sewer Appeal Request For Sewer Fee Adjustment

NOTE: The information provided on this form will be used to adjust your sewer fee for water consumption that is not disposed of through the City's wastewater collection system. Sewer Fees are based on your average water consumption for the winter months billed in January, February and March of this year. If you believe the water consumption for these three months is a misrepresentation of your water that is disposed of through the City's wastewater collection system, please complete the following information. Find sewer appeal process information at our Sewer Appeal Q & A.

1
Have you had a home irrigation check in the past 12 months?
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2
Did you submit a request for sewer fee adjustment last year?
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3
Customer First Name:
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4
Customer Last Name:
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5
Service Address:
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City:
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State:
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Zip Code:
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9
Home Phone:
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10
Cell Phone (optional):
11
Email Address:
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12
Account Number:
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13
Any changes on water usage from last year?
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14
Number of Occupants in Household:
 *
15

Winter Lawn square footage (Length x Width=Square Footage):

Please enter numbers ONLY for the total square footage.  Enter 0 if none.

16

Garden square footage (Length x Width=Square Footage):

Please enter numbers ONLY for the total square footage.  Enter 0 if none.

17

Total Number of Trees :

Please enter numbers ONLY.  Enter 0 if none.

18

Total Number of Shrubs:

Please enter numbers ONLY.  Enter 0 if none.

19

Total Square Footage of Pool, Spa, Fountains and Ponds (Length x Width=Square Footage):

Please enter numbers ONLY for the total square footage.  Enter 0 if none.

20

Were any leaks detected and repaired during the months of January, February or March?:

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21

Estimated leakage in gallons per month:

Please enter numbers ONLY.  Enter 0 if none.

NOTICE:

* Copies of actual receipts for materials purchased and/or work done MUST be submitted.

* Appeal will be denied if no documentation is provided.

* Fax receipts to: 623-932-3003 or Email them to: gyutilities@goodyearaz.gov

* If you are unable to fax or email copies of the required documentation to process your appeal they can be dropped off or mailed to:

City of Goodyear

Attention Utilities-Sewer Appeal

190 N. Litchfield Rd.

Goodyear, AZ 85338

22
Was your pool filled and/or repaired during the months of January, February or March?
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23
Did you have pool repairs during the months of January, February or March?
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24
If your pool was filled was it the initial fill?
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25

Number of gallons added to pool due to a repair or initial fill:

Please enter numbers ONLY.  Enter 0 if none.

NOTICE:

* Copies of actual receipts for materials purchased and/or work done MUST be submitted.

* Appeal will be denied if no documentation is provided.

* Fax receipts to: 623-932-3003 or Email them to: gyutilities@goodyearaz.gov

* If you are unable to fax or email copies of the required documentation to process your appeal they can be dropped off or mailed to:

City of Goodyear

Attention Utilities-Sewer Appeal

190 N. Litchfield Rd.

Goodyear, AZ 85338

26

Total number of Livestock at property:

Please enter numbers ONLY.  Enter 0 if none.

* Definition for appeal purposes is a horse or a 4 legged food producing animal.

* Household pets do not qualify as livestock.

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Additional Comments:
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The above information is accurate to the best of my knowledge. I understand that the given values are subject to verification and if there is an error, I will be charged for any incorrect allowance not previously billed. Any allowances, based on the information provided will be reflected in future bills.  Please call the Finance Department at 623-882-7887 with questions.

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