Water Leak Adjustment Online Form

Press Enter to show all options, press Tab go to next option

Water Leak Adjustment

This is a form you can complete online and then email directly to the appropriate staff member at the City of Kalama.  If you would prefer to print and complete the form to send to the City offices, click here

Please correct the field(s) marked in red below:

Before completing this form, please review the Water Leak Adjustment Policy which outlines the conditions for which a leak adjustment is allowed.  By submitting this form you acknowledge you have read the Policy





I request that my water/sewer bill be adjusted.  I understand that while consideration of this request is pending, I am responsible to make a payment equal to the amount of the last previous unchallenged bill plus one half of the difference between the water charge on the challenged bill and the average water charge in order to avoid a late fee.  Water Leak Adjustment Policy

By submitting this form, I CERTIFY that all statements and information furnished on this form are true, complete and correct to the best of my knowledge and belief, and are made in good faith.  I understand that statements or information furnished on this form are subject to verification and I agree to furnish supporting documents or information when so requested and/or names, addresses and phone numbers (if known) of officials or other individuals who can substantiate the above information.  I also understand that intentional misstatements or falsification may result in disciplinary action.


  1. To receive a copy of your submission, please fill out your email address below and submit.

    Free viewers are required for some of the attached documents.
    They can be downloaded by clicking on the icons below.

    Acrobat Reader Download Acrobat Reader Flash Player Download Flash Player Windows Media Player Download Windows Media Player Microsoft Silverlight Download Microsoft Silverlight Word Viewer Download Word Viewer Excel Viewer Download Excel Viewer PowerPoint Viewer Download PowerPoint Viewer