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2. First Name*
3. Last Name*
5. Address*
7. Email Address*
8. Phone Number*
10. Purpose of Water Use

    Please provide a reason for the requested variance (new lawn or landscaping, vacation, etc).

12. Specific Provisions

    Please provide the specific part(s) of the water restrictions plan from which you're requesting relief (watering three days a week, watering on specific days, etc). 

14. Detailed Statement

    Please provide a detailed statement as to how the specific provision(s) of the water restrictions plan provided above adversely affects you, or what damage or harm will occur to you or others if you comply with the water restrictions. 

16. Description of Relief Requested

    How would you like to use water that differs from the current water restrictions?

18. Period of time for which variance is sought
    Period of time for which variance is sought Start Date

    Period of time for which variance is sought Start Time

    —

    Period of time for which variance is sought End Date

    Period of time for which variance is sought End Time
20. Alternative Water Use Restrictions

    Please provide alternative water use restrictions you are planning to take to comply with the current water restrictions (limiting indoor water use, using the cycle and soak method of irrigation to reduce runoff, etc). 

22. Additional Information

    Please provide an other pertinent information. 

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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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