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White Copy – File Yellow Copy – Water Department Pink Copy – Finance Department C:\Users\peggyki\Desktop\New Service Forms\WATER SERVICE FORM 4-2019REV.doc CITY OF WOODBURN PUBLIC WATER SERVICE APPLICATION Building Permit Number Receipt Number Meter Deposit Number Date ADDRESS WHERE STRUCTURE AND / OR SERVICES ARE TO BE LOCATED Applicant / Owner Phone Number Service Type Single-Family Commercial Industrial Multi-Family (Number of Units) Other MFD (In Park) Type and Size of Water Service Requested Domestic Size Irrigation Size Fire Sprinkler Size Signature of Applicant Sequence # Account # Meter Reading Week Route Date Water Meter Installed Domestic Meter # ID # Irrigation Meter # ID # Fire Sprinkler Meter # ID #