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Water Budget Variance Application

2. Monte Vista Water District customers are allocated a water budget based on their estimated indoor and outdoor water needs. By staying within budget, customers pay a lower rate. Variances are available to help single-family residential customers and dedicated irrigation metered customers who exceed their budget for one of the reasons listed below. To request an adjustment to your water budget, please submit this completed online form along with requested supporting documentation.

   Monte Vista Water District customers are allocated a water budget based on their estimated indoor and outdoor water needs. By staying within budget, customers pay a lower rate. Variances are available to help single-family residential customers and dedicated irrigation metered customers who exceed their budget for one of the reasons listed below. To request an adjustment to your water budget, please submit this completed online form along with requested supporting documentation.

4. Account Number*

5. Service Address*

7. ******* CHOOSE THE APPROPRIATE VARIANCE CATEGORY FROM THE LIST BELOW ****************
   Once a category is selected, you will be prompted for more information based on the category chosen. Applications must be complete with all information and applicable supporting documentation uploaded in order to be processed and approved.

   Once a category is selected, you will be prompted for more information based on the category chosen. Applications must be complete with all information and applicable supporting documentation uploaded in order to be processed and approved.

11. Permanent Variance

    1. Irrigated landscape is greater than the District's estimate

13. Actual Landscape Area (sq.ft.)

14. Landscape Photo and/or Sketch*

    Provide photos and/or a sketch of the landscape area (see example on bottom of form).

16. Additional Photo of Landscape

17. Additional Photo of Landscape

18. Additional Photo of Landscape

22. 1-Year Variance

    1. More than four (4) full-time residents living in the home
    2. Child, Adult, or Elder Care Facility
    3. Personal Medical Needs
    4. Livestock or Large Animals Over 100 Pounds

24. Total Number of Residents

25. Names, Ages and Relationships

    Please list the names, ages and relationships for all full-time, year-round household residents. The District reserves the right to require documentation or other verification for a full-time resident.

27. Type of Care Provided
    -- Select One --24-Hour CareDay Care

28. Total Persons Currently Cared for

29. Copy of Valid License*

    Please submit a copy of a valid license issued by California Department of Social Services.

31. Medical Needs/Device Documentation*

    Please submit documentation (such as a letter from health care provider, medical device receipt, etc.).

33. Medical Device

34. # of Dishwasher Loads

35. # of Laundry Loads

37. # of Toilet Flushes

38. # of Baths

39. # of Showers

41. Type(s) of Animal(s)

43. # of Animal(s)

44. Estimated Daily Water Use (in gallons)

48. Temporary Variances

    1. Establish New Landscaping
    2. Leak Repaired
    3. Pool Fill
    4. Other

50. Date Installed

51. Plant Type

52. Measurement of Area (sq.ft.)

54. Visual of New Landscape*

    Provide photos and/or a sketch of the landscape area (see example on bottom of form).

55. Additional Photo of Landscape

56. Additional Photo of Landscape

58. Proof of Repair*

    Submit proof of repair such as before/after photos or receipt from plumber.

59. Date of Repair

61. Fill Date

62. Pool Length (ft.)

63. Pool Width (ft.)

64. Pool Depth (ft.)

66. Gallons

67. Pool Photo

    If application is for first fill of newly built pool (including above ground pools), please submit a photo.

69. Other

    There may be other instances where an increased allocation on a temporary basis may be appropriate. If you believe that is the case, please explain in detail and provide any supporting documentation in the file upload below.

71. Other - Supporting Documentation

75. I affirm, under penalty of perjury, that I am the above account holder and the information contained herein, including supporting documentation, is complete and accurate. I further understand that all applications are subject to review and I may be liable for back charges if I provide incorrect information.

77. Name*

78. Email*

80. Electronic Signature*

81. Phone*

83. Please allow 30 days to process your request. Once approved, an adjustment will be applied to future billing(s) and are not retroactive. Incomplete applications, including applications without supporting documentation, will be returned without review.

87. Landscape Drawing Example
    

    This example illustrates the key information that must be included in your drawing when requesting a temporary or permanent landscape variance. Photos of the landscaped area are welcomed and may be requested.

Leave This Blank:


89. 1. Receive an email copy of this form.
90. Email address

    This field is not part of the form submission.

91. Submit

* indicates a required field