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Builders / Land and Mapping
New Address Request
For property address, structures and/or utility services.

NOTE: Required fields are indicated in red. They must be completed for the Address Request to be processed. If you do not have the required information, please obtain it before completing this Address Request.

Use Type
Residential    Commercial     Multi-Use (choose only one)
Additional Meter Request (For Code Enforcement)
Is this request for an additional meter on property zoned for Residential or Agricultural use?  Yes     No   
NOTE: Additional Meter requests on residential or agricultural property require residential zoning approval by appropriate code enforcement agency. To obtain a "Request For Additional Meter" form, call 729-8628 or send an email to address.assignment@mlgw.org. Requesting customer must complete top portion of form and submit to appropriate code enforcement agency. Code enforcement will complete and forward directly to MLGW. Customer will be contacted upon receipt of the completed form.
Will this address be fed from existing service?  Yes     No   
Will this address be separately metered?  Yes     No   
Location Description
Is the lot in a subdivision? Yes
   No
Site Plan
Attach surveyed site plan (DWG, TIF, PDF, SHP, GIF, JPG - DWG preferred)  
Please email AutoCad site plans to Address.assignment@mlgw.org
We will process your request upon receipt of drawing file(s).

Person Requesting (Owner Representative)
    
Contact Name:Company:   
Contact Phone: Contact Cell Phone: 
(e.g., 901-555-1234) Contact Fax:
Contact E-mail:
Owner/Responsible Party for Property/Address
Owner Name:   
Contact Name (if different from owner): 
Company Name (if applicable): 
Address: 
City:   State:   ZIP: 
Contact Phone: Contact Cell Phone: 
Contact E-mail:  Contact Fax: 
Purpose of Address
Choose One:
New Residential House
Additional Residential Meter*
New Commercial Bldg
Commercial Suite/Bay
Barn
Billboard
Cable Equipment
Cell Tower (Tower Owner)
Cell Service Provider (Co-locate on Tower)
Clubhouse
Fire Pump
Fire Evacuation System
Garage/Detached Dwelling
Gate
 Guard House
HSE Meter
Irrigation
Laundry Facility
Leased Outdoor Lighting (Requires review by LOL)
Mail Kiosk
Project Address to be used during construction
Property Address
Pool
Sewer Lift Pump
Sign
Telephone Equipment
Well
OTHER (Explain below)
Indicate if any of the following apply
Demolition
Meter Separation(separating one meter into two or more)
Meter Combination(combining two or more meters into one)
None apply
Special Instructions



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