Skip to content Skip to footer

Water Turn On Application

This application is for water, sewer, and solid waste. Rates are set by Ordinance and can be found on our website. You may email your application to j.hayward@galenaks.gov or drop it by the office at 211 W 7th St. Galena, Kansas 66739.

UTILITY REQUEST FORM
ADDRESS TO BE TURNED ON
PROPERTY OWNER INFORMATION
Address

_____________________________________________________________________________________________

RENTER INFORMATION
Address

___________________________________________________

Drag & Drop Files, Choose Files to Upload
PLEASE UPLOAD A PHOTO ID OR CURRENT DRIVERS LICENSE.
BILLILNG ADDRESS IF DIFFERENT FROM PROPERTY LOCATION
BY SIGNING THIS FORM I UNDERSTAND THAT I AM RESPONSIBLE FOR ANY BILLS THAT ARE ACCUMULATED AT THIS ADDRESS AS LONG AS THE ACCOUNT IS IN MY NAME. I UNDERSTAND THAT I WILL BE BILLED FOR THIS ADDRESS UNTIL I CONTACT CITY HALL AND HAVE THE WATER TAKEN OUT OF MY NAME.
Date / Time

Attachments