2. 

3. 
   

   City of Fayetteville

   utility@fayetteville-g.gov

   
   

   Customer Service

   210 Stonewall Avenue W

   Fayetteville, GA  30214

   (770)460-4237

5. Applicant's Name*
6. Email Address*
8. Are you the account holder?*

   1. Yes
   2. No
9. Customer Account Number*
11. Address (Address where leak occured)*
13. City*
14. State*
15. Zip Code*
17. Your Contact Phone Number*
19. Leak Information
21. Repair Date*
    Repair Date
22. Was this an indoor or outdoor leak?*

    1. INDOOR
    2. OUTDOOR
23. Was this a pool repair or seasonal fillup?*

    1. Yes
    2. No
25. Estimated period that the leak occurred
27. Beginning Date:
    Beginning Date:
28. End Date:
    End Date:
30. Please explain briefly what type of leak you had. (i.e., toilet valve, irrigation line, water line outside, water line in basement, etc)*
32. Attachment*

    Please submit one of the following required documents to this application:

    • A plumbers repair bill (if you hired a plumber)
    • A receipt for parts (if you made the repair yourself)
    • A notarized letter explaining what was done to correct the problems
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field