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Leak Adjustment Request - Form

  1. City of Lafayette Logo
  2. Leak Adjustment Request Form

    Residents who receive water utility services from the City of Lafayette may request for a leak adjustment if you:

    -Have repaired the leak

    -Have documentation providing proof of repair

    -Have not had a leak adjustment in the past 3 years

    You may request up to 2 consecutive months in which the leak occurred.

  3. Example: 00-0000-00

  4. Explain the location of the leak and what repairs were made.

  5. Proof of Repair
    Upload one or more files in PDF format to submit proof of repair. This can be a bill from a plumber, receipt of parts purchased, etc. Additional information may be requested.
  6. Leave This Blank:

  7. This field is not part of the form submission.