Form Center

2. City of Newport News
   Waterworks Department
   700 Town Center Drive, Suite 400
   Newport News, Virginia 23606-4700
   Phone: (757) 926-1101 (option 1)  
   E-mail: wwnewservice@nnva.gov

4. REQUESTOR'S INFORMATION
6. Date*
   Date
8. Requestor's Name*
9. Company Name
11. Billing Address
12. City, State, Zip Code
14. E-mail*
15. Phone*
17. LOCATION INFORMATION
19. Project Name*
20. Project Number
22. City/County*
23. State*
24. Zip Code*
26. Lot #*
27. Address*
28. Meter Size Requested
    -- Select One --5/8"3/4"1"1 1/2"2"
30. Lot #
31. Address
32. Meter Size Requested
    -- Select One --5/8"3/4"1"1 1/2"2"
34. Lot #
35. Address
36. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
38. Lot #
39. Address
40. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
42. Lot #
43. Address
44. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
46. Lot #
47. Address
48. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
50. Lot #
51. Address
52. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
54. Lot #
55. Address
56. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
58. Lot #
59. Address
60. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
62. Lot #
63. Address
64. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
66. Lot #
67. Address
68. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
70. Lot #
71. Address
72. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
74. Lot #
75. Address
76. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
78. Lot #
79. Address
80. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
82. Lot #
83. Address
84. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
86. Lot #
87. Address
88. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
90. Lot #
91. Address
92. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
94. Lot #
95. Address
96. Meter Size Requested
    -- Select One --5/8"1/2"1"1 1/2"2"
98. Lot #
99. Address
100. Meter Size Requested
     -- Select One --5/8"1/2"1"1 1/2"2"
102. Lot #
103. Address
104. Meter Size Requested
     -- Select One --5/8"1/2"1"1 1/2"2"

106. You understand that by typing your name below you are electronically signing this document.

107. Check here*

     1. I understand
109. Signature*

111. Revised Sept 2021

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113. 1. Receive an email copy of this form.
114. Email address

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115. Submit

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