Pool Credit Form

To financially assist residents when filling their pools for the season, they are entitled to a once-a-year credit on the sewer portion of their water/sewer bill. In order to receive the credit, you must record the beginning and ending meter readings and dates you filled the pool. We will also need the date that your zoning permit was issued and the dimensions of the pool. If you have questions, please call Village employees at 419-877-5383.

Beginning Meter Reading*
Beginning Reading Date*
Ending Meter Reading*
Ending Reading Date*
Pool Dimensions*
Date Zoning Permit Issued for Pool Placement
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Water Account No.
Acknowledgement Signature*
All of the information submitted is true and accurate. I understand that this is a once a year pool fill credit and is a waiver of the sewer charges associated with this pool fill. I understand I am still responsible to pay the water portion associated with this pool fill.
- I acknowledge
- I do not acknowledge