Oakland County WRC Disconnect Application
Disconnect Address
City / Village / Township
Account #:
Reason for Disconnection
Please select one item in each section.
Demolish: Residential
Demolish: Non-Residential
Rebuilding
Not Rebuilding
Changing Line Size
Other
What Services will be Disconnected? (Select All that Apply)
Disconnect Water?
Disconnect Sewer?
Disconnect Grinder Pump?
For Water Disconnection
Disconnect Service at the:
Water Main
Stop Box
The service may not be reconnected in the future, depending on the service line material and size.
For Sewer Disconnection
Bonded Contractor Name
Contractor Phone Number
Surety Expiration Date
For Grinder or Pump Station Disconnection
Remove: The structure will be demolished and not rebuilt.
Relocate: The structure will be demolished / an addition to the building requires station relocation.
Take Out of Service: Pump will be taken out of service, but remain in place, due to work on the building.
Applicant Information
First Name
Last Name
Email
Phone
Address
City
Zip Code
Signature
Date