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Instructions
Utility customers should use this form to indicate their interest in the Private Lead Service Line Replacement Program through the City of Milton. A printable version of the form is also available on the City's website: www.milton-wi.gov/LSLInterestForm.
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What type of line do you have at your property?
Take a moment to determine what type of service line you have at your property. Go to where the water service line enters your home and connects to your water meter. It is usually located in the basement and possibly closer to the street side of the home. The photo to the left shows a water meter connected to the water line.
Lead Pipe
The scratched area is shiny and silver. A magnet will not stick
Copper Pipe
The scratched area is copper in color, like a penny. A magnet will not stick.
Galvanized Steel Pipe
The scratched area remains a dull gray. A magnet will stick.
I believe my service to be made of
1. Lead
2. Copper
3. Galvanized Steel
4. Plastic
5. Unsure
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Physical Property Address
Property Type
1. Residential
2. Other
If you answered "Other" to the question above, please describe your property type.
Owner Name as Indicated on Deed
Only residential properties owned by an individual(s) are eligible.
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Please initial under one of the options below.
Yes, I am interested in participating in the Lead Service Replacement program.
You will be contacted by Water Utility representatives.
No, I am not interested in participating in the Lead Service Replacement program. I understand that if private service line replacement becomes mandatory, I may be 100% responsible for the replacement cost.
Property Owner's Electronic Signature
Date

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