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2. Lakehaven Water and Sewer District
   31627 1st Avenue S
   P.O. Box 4249
   Federal Way, WA 98063-4249
   Federal Way: 253-941-1516
   Tacoma: 253-927-2922
   Fax: 253-839-9738
   www.lakehaven.org
3. Today's Date
   Today's Date
7. Service Address:
9. City:
10. State:
11. Zip Code:
13. Reason for Request:
15. Suspension Agreement
    As the owner of the property at the service address designated above, I hereby request Lakehaven Water and Sewer District suspend the water and/or sewer charges for a 6 month period with the provision that upon my request and the district's approval this suspension could be extended 1 time if necessary. (Select one option below.)
17. Option 1:

    I am requesting the water meter be locked and sewer charges suspended for a 6 month period. I understand that there will be a dormant charge per month charged for water.

    1. I Accept
19. Option 2:

    I am requesting that the sewer charges only be suspended for a 6 month period. I agree that no house water, surface water, or infiltration of unauthorized material shall enter the sewer system during this period of time. If extension is not requested and approved by the end of the 6-month period, sewer charges will resume as previously billed.

    1. I Accept
21. Option 3:

    I am requesting that the water meter be removed and I will be charged the district’s current rate for such disconnection of the meter and the sewer charges be suspended for 6 month period. I understand there will be a re-connect charge for the water meter.

    1. I Accept
23. Home Phone Number:
24. Cell Phone Number:
25. Work Phone Number:
26. Other Phone Number:
28. Email Address
    Please provide your email address if you would like us to respond via email.
    
    (If you would like a copy of this form emailed to you, you must enter your email again in the submission section of this form.)
30. First Name
31. Last Name
33. Signature:*

    By marking the box below you are agreeing that all the information you provided is correct.

    1. I Agree
35. By:
36. Date
    Date
38. Note:
    It is the obligation of the customer to notify the district should the structure become inhabitable prior to the end of the 6 month suspension period.
42. Print Option
    For best printing results, check the box to "Receive email copy" and provide your email address.
    
    Look for an email with subject line of: "Online Form Submittal: Lakehaven Request for Temporary Suspension of Charges Form". Ensure that your email program does not block email from "noreply@CivicPlus.com".
    
    Print the email from your email program.
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46. 1. Receive an email copy of this form.
47. Email address

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