Annual Sewer Rebate Application

Waterford Utility Commission 
1000 Hartford Turnpike 
Waterford CT, 06385 
ANNUAL SEWER REBATE APPLICATION 
This form must be filled out completely and returned to the Utility Commission Office in order to be considered for sewer 
rebate. Complete this form at the end of your season or billing period; please include both starting and ending consumer 
meter readings with dates. For first time submittals, pictures of the meter with start and end reads are required. For 
subsequent submittals for active subscribers, only ending read pictures are required. Consumer meters must be installed, 
maintained, and read by the customer and are subject to inspection by Waterford Utility Commission personnel or their 
agent.  
A separate form must be filled out for each account. 
Customer Account Number: 
Metered Address: 
Owner(s): 
Mailing Address: 
Telephone Number: 
I hereby apply for a reduction in the sewer use charges for the above metered address for the calendar year of: 
in accordance with Waterford Utility Commission policies. The water usage indicated below did not enter 
the sanitary system. 
Start Reading: 
     CF Date: 
Picture Included: ☐ Yes ☐ No ☐ N/A 
End Reading: 
     CF Date: 
Picture Included: ☐ Yes ☐ No 
Owner Signature: 
For Office Use Only 
Total water not discharged to the sanitary sewer system:  
C.F.
Sewer Rebate Amount:  $ 
☐  New Customer  
[ $50 application fee received?  ☐ Yes ☐ No ] 
☐Existing Customer
Approved  
Date 
RETURN COMPLETED APPLICATIONS & PICTURES TO THE WATERFORD UTILITY COMMISSION: 
IN PERSON AT: 
1000 Hartford Turnpike, Waterford, CT 06385 
BY MAIL:  
PO Box 310, Waterford, CT 06385 
BY EMAIL: 
wuc@waterfordct.org 
Applications must be submitted by December 31 for continued participation in the program. 
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