Account Number *

Street Number, Zip Code

Day Time Phone No. *

Email Address *

City of Houston ordinance, Section 47-74, allows for a Leak Adjustment credit for the loss of water through an “excusable defect” in the customer’s water line. An excusable defect is a leak caused by city personnel, a city contractor, freezing weather, settlement, corrosion, wear or accident, not caused by customer negligence or disregard of water line or fixture maintenance. “Excusable defect” does not apply to any defective or out-of-repair plumbing fixtures that are exchangeable devices or components attached to the plumbing system to deliver or drain water. Leaks such as faucet, hose and toilet leaks are ineligible.
If eligible, credit is issued as a percentage of total excess water usage. Credit percentage is determined by number of days lapsed before repairing the private leak. The credit is as follows: 100% for customers repairing 30 days after leak began, 75% for repairing within 60 days after leak began, 50% for repairing more than 60 days after leak began.

I am the Responsible Party for the account at the above service address. (Give full legal name and/or business identity)

ResponsibleParty *

I am asking the City of Houston to reduce the water bills for this account, to the extent allowed by city ordinance because of a leak beginning on (date)

Leak Date: *

and repaired on (date)

Leak Repair Date *

During this period, the following additional water appliances (washer, dishwasher, spa, etc.) were installed at the service addres State “NONE” below, if none were added The water lost from this leak was not used by anyone.

IN ORDER TO PROCESS YOUR APPLICATION QUICKLY & EFFICIENTLY, PLEASE READ THE FOLLOWING CAREFULLY AND GIVE A COMPLETE AND CLEAR DESCRIPTION OF THE REPAIRS.

Type of leak on customer’s side of meter and description of repair

TypeOfLeak *

LeakDescription *

Attach documentation of the repair date, address, type of repair, and cost. Acceptable documents include plumber’s statement/bill or a receipt for parts. Businesses with in-house maintenance may submit a statement signed by two (2) employees who witnessed the repair.
In all cases the City retains the right to make field verifications before approving leak adjustments. You will be notified by mail generally within 90 days whether your request is approved or denied.

I am familiar with all of the facts stated in this document and they are true and correct. Making false statements on this government record is subject to criminal prosecution under Chapter 37 of the Texas Penal Code. I certify that this application and attached documents contain no false statements.