Documents & Forms

Customer Service

Form	Description
Billing Adjustment Request Opens in New Window Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed and submitted by the customer with their original invoices or receipts for proof of repair of a leak or pool filling for consideration of a billing adjustment.
Municipal Assessment Form Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed and submitted to request information pertaining to liens and all monies owed for water / sewer or solid waste assessments.
Notarized Statement of Repair Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed and submitted by the customer if the original repair invoices or receipts are not available for proof of repair or pool filling for consideration of a billing adjustment.
Unexplained High Water Use Adjustment Request Form Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed and submitted by the customer for an investigation into an unexplained high water usage occurrence.

Engineering & Contract Management

Form	Description
Agent of Record Opens in New Window (PDF-WCAG) Opens a New Window.	Letter from Owner/Developer granting engineer of record or his agent permission to act on the owner’s behalf.
Availability of Service Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed by the Owner/Developer or the engineer requesting confirmation of utility services for a given parcel(s) for financial purposes.
Bill of Sale Opens in New Window (PDF-WCAG) Opens a New Window.	To be submitted by the Owner/Developer to convey utilities constructed in the public right of way to the County.
Commercial Collection License Opens in New Window (PDF-WCAG) Opens a New Window.	License to collect and dispose of solid waste in unincorporated Pasco County.
Commercial Wastewater Flow Rates/Calculations Opens in New Window	Guidelines for determining wastewater flow rates. Florida Administrative Code, Department of Health, Division of Environmental Health, Rule: 64E-6.008,
Dry Line Approval Letter of Understanding for Water Opens in New Window (PDF-WCAG) Opens a New Window.	To be completed by the Owner/Developer acknowledging proposed construction of the water line will have no connection to existing water lines.
Dry Line Approval Letter of Understanding for Wastewater (PDF-WCAG)	To be completed by Owner/Developer acknowledging proposed construction of the wastewater line will have no connection to existing wastewater lines.
Engineer of Record’s Cost Estimate Opens in New Window (PDF-WCAG) Opens a New Window.	Engineer to submit this listing the pipe, etc., and its cost to construct the utilities in the public right of way to be conveyed to the County.
FDEP Construction Water Permit Application Opens in New Window	To be used by the project engineer to apply for a Florida Department of Environmental Protection permit for construction of water lines, etc., in the public right of way. This application is normally used where phasing of the project is required.
FDEP Permit Application Checklist Opens in New Window	Outlines the requirements for submitting the FDEP permit package.
FDEP Permit Clearance Checklist	Outlines the requirements for submitting the FDEP certification of completion package.
FDEP Reclaimed Water Permit Application Opens in New Window	Notice of Intent to Use General Permit for Addition of a Major User of Reclaimed Water. Used by the project engineer to apply for a Florida Department of Environmental Protection permit for construction of reclaimed water lines, etc., in the public right of way.
FDEP Wastewater Permit Application Opens in New Window	Notification/Application For Constructing A Domestic Wastewater Collection/Transmission System. Used by the project engineer to apply for a Florida Department of Environmental Protection permit for construction of wastewater lines, etc., in the public right of way.
FDEP Wastewater Clearance Application Opens in New Window	Request For Approval To Place A Domestic Wastewater Collection / Transmission System Into Operation. This form is used by the engineer of record to certify the completion of the wastewater collection system under the Florida Department of Environmental Protection wastewater permit.
FDEP Water Clearance Application Opens in New Window	Certification of Construction Completion and Request for Clearance to Place Permitted PWS Components into Operation 962-555.900(9). This form is used by the engineer of record to certify the completion of the water construction project under the Florida Department of Environmental Protection water permit.
Jumper Meter Request Opens in New Window (PDF-WCAG) Opens a New Window.	This form is to accompany customer payments for a Jumper Meter.
Letter of Credit Opens in New Window (PDF-WCAG) Opens a New Window.	Sample of a type of maintenance guarantee to warranty utilities for one year.
License-Maintenance Agreement-CDD Opens in New Window (WCAG) Opens in New Window	This agreement is required whenever a developer, HOA or CDD proposes to place landscaping and/or fencing on County Utility property. The agreement requires the Licensee to assume all liability and responsibility including paying all costs for installation and maintenance of the landscaping and/or fencing.
Maintenance Bond (PDF-WCAG)	Sample of a type of maintenance guarantee to warranty utilities for one year.
Merchant’s Agreement Opens in New Window (PDF-WCAG) Opens a New Window.	Form of the agreement between multiple owners for usage and maintenance of a private pump station. To be reviewed and approved by PCU prior to recording by the owners.
FDEP Permit Fee Application (PDF-WCAG)	Form needs to be signed by the owner/developer and engineer agreeing to Pasco County’s terms and conditions and payment of commitment and permit fees.
Pressure Main Data Test Sheet (PDF) Opens a New Window.	Form to be used by the engineer or his representative and County inspectors when conducting a pressure test of the water, wastewater or reclaimed water mains.
Service Connection Application-Single Residential/Commercial (PDF) Opens a New Window.	Form is to be completed by the owner/developer or the engineer of record for a specific proposed project to request utility services, determine meter size and to calculate all appropriate fees and charges. This form is for a single residential or a commercial project.
Service Connection Application-Subdivision without Reclaim (DOC) Opens a New Window.	Form is to be completed by the owner/developer or the engineer of record for a specific proposed project to request utility services, determine meter size and to calculate all appropriate fees and charges. This form is for a subdivision without reclaim water.
Service Connection Application-Subdivision with Reclaim (DOC) Opens a New Window.	Form is to be completed by the owner/developer or the engineer of record for a specific proposed project to request utility services, determine meter size and to calculate all appropriate fees and charges. This form is for a subdivision with reclaim water.
Service Connection Application for Taps and Jumper Meters (PDF) Opens a New Window.	Form is for contractor’s use to request taps and jumper meters for a given project which must be preapproved prior to submittal of payment of fees by the Planning and Service Commitment section.
Solid Waste Management Program User Charge System Opens in New Window (PDF-WCAG) Opens a New Window.	Guidelines for calculating the fee for solid waste.
Utilities Services Agreement for Water Supply, Wastewater Treatment and Reclaimed Water Supply (DOC) Opens a New Window.	Form to be used as the agreement between Owner/Developer and Pasco County Board of County Commissioners outlining services to be provided and requirements by each party.
Utilities Services Agreement for Water Supply and Wastewater Treatment (DOC)	Form to be used as an agreement between Owner/Developer and Pasco County Board of County Commissioners outlining services to be provided and requirements by each party.
Master Utility Plan Guidelines Opens in New Window (PDF-WCAG) Opens a New Window.	Outlines the requirements for submitting an overall utility site plan for proposed utilities including existing utilities in the surrounding area of the proposed project.
Utilities Standards for Design and Construction (PDF) Opens a New Window.	Standards for design and construction of water, wastewater, fiber optics, and reclaimed water facilities for Pasco County Utilities Department. Revised March 2018.
Customers in need of accessibility assistance with any of the above documents can connect by phone through the Federal Information Relay Service at 800-877-8339 for TTY/Voice communication, via email at UtilCustServ@pascocountyfl.net, or by visiting PascoCountyFL.net/Accessibility for additional support avenues available.