968 Hunt Highway
San Tan Valley AZ 85143
Email application to: santanmeterapps@epcor.com

1.	BILLING INFORMATION

REQUESTED BY:	DATE:	
NAME ON ACCOUNT:	BILLING STREET ADDRESS:	
TELEPHONE:	BILLING CITY, STATE, ZIP CODE:	
EMAIL ADDRESS:	

2.	SERVICE ADDRESS INFORMATION

SERVICE STREET ADDRESS:	CITY:	ZIP CODE:	LOT NUMBER:	
SUBDIVISION / PROJECT NAME:	ASSESSOR’S PARCEL NUMBER:	
FIELD CONTACT NAME:	FIELD TELEPHONE:	SEWER SERVICE PROVIDER:	

METER SIZE:				3/4”	1”	1-1/2”	2”	3”	Other  	
Note: For 1” meter or larger requests for Residential Single Family, include documentation that meter size is needed.	

3.	PURPOSE OF SERVICE (Please check all that apply)

Residential Single Family
Residential Multi-Family (2 units or more) # of Units  	 Commercial (Type)  	
Types: Carwash, Automotive Service, Hospital, Laundromat,
Medical office, Professional office, Restaurant, School, Other
Commercial, provide NAICS code:  	
Compound Meter Hydrant Meter

Irrigation Only
Fire Line	Size Inches
Sewer Service Line	Size Inches Potable
Backflow Preventer

NOTE TO APPLICANT: A meter will NOT be set if (1) this application is not complete, (2) all fees have not been paid, (3) project does not have final acceptance, or (4) the conditions in the acknowledgement below are not met.

4.	APPLICANT   ACKNOWLEDGEMENT

The undersigned certifies that (1) the lot and address is clearly posted, (2) the meter box and valves meet the required construction specifications, and (3) the meter box is set, level, free of debris and in good condition.

APPLICANT’S SIGNATURE:	APPLICANT’S PRINTED NAME:	DATE:

FOR EPCOR USE ONLY	
GROUNDWATER REPLENISHMENT DISTRICT NUMBER:	
UNDER WARRANTY? YES NO	
WATER LXA #:	SEWER LXA #:	
	
PREMISE #:	CUSTOMER #:	ACCOUNT #:	
ROUTE/STOP #:	

June 23, 2021

Photograph

If this application is for a new housing development, you must provide a photo. A good photo must include:

►   Address posted
►   Lot # posted
►   Meter Box is to grade and is free of all dirt and debris

Please see this reference photo as an example.