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2. Meter Installation Request Form (All fields required)

   Complete this form when requesting installs for 3/4", 1", and 2” water meters, and expect 3 to 5 days for the install upon receipt of the completed form. Please review: Engineering and Infrastructure Design Standards: page 48 (general info), pages 279-280 (meter design and inspections) and the Water-Wastewater Inspection for C.O. and Meter & Curb-stop specifications. For further assistance, call 970-344-5015 or email Berthoud Water Systems Operations Staff

4. Date of Request*
5. Building Permit Number*
7. Tap Fees Paid*
   -- Select One --YesNoNot Applicable

   Impact fees are paid in advance of meter installation(s)

8. Property Type*
   -- Select One --ResidentialMulti-familyCommercial / Non-ResidentialIrrigation (Commercial)
10. Site (Property) Address and note nearby Intersections*
12. (1st) Meter Size and Quantity*
13. (2nd) Meter Size and Quantity
15. Company and Contact Name*
16. Are you the Site*
    -- Select One --OwnerProperty ManagerContractor
18. Contact Address, City, State, Zip Code*
20. Contact Email Address*
21. Contact Phone*
23. If not the Owner, Name of Owner and Company, and their phone and email
25. If you received a Failed Notice for Meter Install, please note if Repairs have been completed.
27. Water Usage Survey / For Multifamily-Commercial-Common Area Properties
    Water Use Site Survey

    For non-single residential sites, submit the Water Use Site Survey if you haven’t already. Upload it to your building permit portal and email backflow@berthoud.org. This survey is required by the CO Dept Public Health & Environment for new or modified water connections and filed with Water Utilities backflow prevention division. Questions, email backflow@berthoud.org.  *This is not required for single-family residential homes.

29. Will a Backflow Assembly Install be Required for this Site*
    -- Select One --YesNoNot ApplicableDo not know

    Required by state and local regulations for multi-family properties (excluding duplexes), non-residential/commercial properties, and commercial irrigation with new, upgraded, or replacement water connections.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field