2. Sump Pump Fee Waiver Certification Form
4. Account Number
   The account number appears at the top of the monthly utility bill.
5. 
7. First Name
8. Last Name
10. Address
12. City
13. State
14. Zip Code
16. Phone Number
17. Email
19. 1. The undersigned homeowner (occupant) verifies at (for the property listed) a sump pump does not exist or is only capable to discharge water outside.
21. 2. If a sump pump is present at the property a photo showing no connection to the sewer system must be submitted with this form.
23. 3. The homeowner agrees that if they install a connection to the sewer system that they will notify the City of West Fargo of this change, by filling out a seasonal sump pump variance form.
25. 4. City of West Fargo Ordinance 9-0328 will be enforced and the undersigned homeowner (occupant) agrees to all conditions as listed in City of West Fargo Ordinance 9-0328.
27. Photo upload
    Upload a photo showing no sump pump is present at this property.
29. Additional Comments
31. Certification*

    1. By checking this box, I certify these conditions are met.
Leave This Blank:


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

    This field is not part of the form submission.

34. Submit

* indicates a required field