2. 

3. TOWN OF MILTON
   WATER & WASTEWATER DIVISION
   PHONE: 802-893-6030
   EMAIL: telwood@miltonvt.gov

7. Water Shut Off/Turn On Request

9. Applicant Information

11. Name*
12. Email Address*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
22. Is the owner the same as the applicant?*
    -- Select One --YesNo
24. Owner Name
25. Email Address
27. Address
29. City
30. State
31. Zip Code
33. Phone Number

37. Property Information

39. What type of service are you requesting?

    1. Shut water off
    2. Turn water on

    Check all that apply

41. Physical Address*
43. Reason for request*
45. Shut Off Request
    Shut Off Request

    Shut Off Request
46. Turn On Request
    Turn On Request

    Turn On Request

48. Please note that someone must be present on site at the requested date and time

50. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    By checking the "I agree" box below, you understand that someone will need to be present at the home, on the requested date and time.

    1. I agree.
52. Electronic Signature*
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

* indicates a required field