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Cocoa Reclaim Water Service Interest Form

  1. Relationship to the Property*

    Check all that apply.

  2. Do you agree to the the following?*
    • I have read and understand the New Customer Orientation Package and will have my irrigation system inspected prior to service start up. 
    • I understand that orientation will be required prior to physical connection to the system. It is further agreed that the City shall have the right to enter the above premises as deemed necessary at any time to inspect the reclaimed water piping, fittings and operation of the irrigation system.
  3. Leave This Blank:

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