2. 

3. City of Fayetteville

   Water and Sewer Department

   utility@fayetteville-ga.gov

   
   

   Customer Service

   210 Stonewall Avenue W

   Fayetteville, GA  30214

   (770)460-4237

5. Date*
   Date
7. Business/Customer Name:*
9. Business Contact or Representative:*
10. Email Address:*
12. Billing Address*
14. City*
15. State*
16. Zip Code*
18. Business Phone Number:
19. Cell Phone Number:*
21. Location of Hydrant to Be Used:*
23. Specific Purpose of Use:*
25. How Many Days Needed For:*

27. Permit holder has read and agrees to the Hydrant Meter Policy and all terms and conditions of the permit. Violation of the Policy or any specified or implied condition constitutes ground for immediate revocation of the permit and equipment. The permit holder agrees to relinquish the meter to the City of Fayetteville Customer Service Department at any time.

29. Customer Signature*
30. Date*
32. Confirm Signature*

    1. *

    I certify that the information contained is true and accurate as of this date.

36. For Office Use Only:
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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