Name on Account:
Service Address:
Utility Account Number:
Contact Number:
Date to be Locked:
Date to be Unlocked:
WHILE HOME IS VACANT PROVIDE THE FOLLOWING:
Keep Irrigation or Reclaim Water Meter On?	Yes No N/A
Mailing Street Address:
City:
State:
Zip:
Email:
Additional Comments:

I understand and agree that I am entitled to one (1) turn off and one (1) turn on per calendar year at no charge. A fee of $35.00 shall be assessed for all additional turn off and turn on requests during normal business hours or a fee of $162.00 shall be assessed if after normal business hours,as in accordance with City of Venice Code of Ordinances, Chapter 74, Sec 74-8 (c), as amended.