Service Line Material Self-Reporting Form

Supporting documentation and customer signature are required to successfully report the private side (customer-owned) of the water service line material.

Download the Service Line Material Self-Reporting From (PDF).

Please complete the form and return to Haltom City Public Works by scanning and emailing to lcrr@haltomcitytx.com with “Self Reporting” in the subject line or by mailing/hand delivery to 4200 Hollis Street, Haltom City, TX 76111.

For any questions, please contact Haltom City Public Works Dispatch at 817-834-9036 or lcrr@haltomcitytx.com.