Variance Request Form

Webform December 27, 2018

This form is intended to be used to obtain general information.

Note: Please do not provide sensitive information such as your Social Security Number, bank account or credit card number, or information that would enable someone to access an online account such as your username and password.

Information about how EMWD will use your information can be found within EMWD's Privacy Policy.

Name: *

Account Number: *

Service Address: *

This form is to request an allocation other than the standard amount EMWD uses for your type of home. If you believe you need an adjusted allocation based on the criteria listed below, you must complete and return this form. The allocation billing system is designed to serve as a tool to help you identify problems such as leaks or over-watering. Using water efficiently helps EMWD keep water rates low by reducing purchases of expensive water from outside the local area. Variances may be approved for any of the following reasons and are subject to periodic review by EMWD.

IMPORTANT! Some variances may not be approved per EMWD’s current drought status. For more information, see EMWD’s Water Shortage Contingency Plan.

I request an adjusted water allocation for the following reason(s):

1. Residents per Household (total number in household):

Please list all names and ages for each person in the household:

Example:
Name: John Doe / Age: 34
Name: Jane Doe / Age: 40

Temporary Household Changes (i.e. long-term guests)
Note: 30 days notice is required prior to start date of temporary request.

Number of Additional People:

Start Date:

End Date:

2. Licensed Elder or Child Care Facility (in a residential unit)
Submit a copy of facility license via email (variance@emwd.org), fax (951-928-6145), or mail (Attn: Customer Service Dept., Eastern Municipal Water District, 2270 Trumble Road, P.O. Box 8300, Perris, CA 92572-8300).

Total number of persons:

3. Medical Needs
Please download the Medical Variance Form and have it signed by your doctor before submitting to EMWD.

4. Irrigated Landscape Area

Total existing irrigated landscape area in square feet:

5. NEW Irrigated Landscape Area (for backyard turf grass only)

NEW Irrigated Landscape Area (for backyard turf grass only):

6. Pools (Filled once every five years) Enter the number of gallons OR the length, width and average depth of the pool.

*Gallons:

*Length:

*Width:

*Average Depth:

7. Large Animals
(weighing more than 100 pounds each)

Number of animals:

8. Other Instances:

There may be instances where an increased allocation on a permanent or temporary basis may be appropriate. If you believe that is the case, please provide the details below and submit any documentation you may have via email (variance@emwd.org), fax (951-928-6145), or mail (Attn: Customer Service Dept., Eastern Municipal Water District, 2270 Trumble Road, P.O. Box 8300, Perris, CA 92572-8300). Our Customer Service Department will contact you regarding your request within 30 business days. Please note that additional documentation may be required.

In most cases, if approved, variances will be applied starting with your next bill.

Email address: *

Daytime Phone (between 8 a.m. and 5 p.m.): *

Include ext. (if application)

Date: *

Electronic Signature: *

By checking this box, I certify that I have completed this form and affirm that I am the above account holder and the information contained herein, including any and all additional documentation submitted via email, fax or mail, is complete and accurate. I further understand that all variances are subject to change, and I may be liable for back charges for providing false information.

To receive a copy of your submission, please fill out your email address below and submit:

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