Swimming Pool Fill Form
(REQUEST FOR WATER ONLY CHARGE FOR FILLING POOL)
Date:
Account #:
Name:
Address:
Phone Number:
Email Address:
Pool Information:
Dimensions of Pool:
Length x Width or Diameter:
Depth of Pool:
I understand that only one pool fill is allowed per calendar year. Topping off a pool is not cause for an adjustment.
Signature Date
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Town of Bath Office Use Only
Average Water Usage (6 mo)
Total Wastewater Credit: