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Drainage Utility Fee Request for Adjustment/Exemption

  1. Staff Use Only
  2. Location ID:
  3. Current Impervious Cover (Square Feet):
  4. Current Stormwater Credit (BMP and Credit Amount):
  5. Revised Stormwater Credit (BMP Type and Credit Amount):
  6. Renewal Requirement (Annual; Only Upon Failed Inspection):
  7. Units:
  8. Billing Code:
  9. Reason for Approval/Denial:
  10. Director of Public Works or Appointee Signature:
  11. Leave This Blank:

  12. This field is not part of the form submission.