2. 
4. Stormwater Utility Petition
   For more information on the petition adjustment process please click here.
6. A.) Site Information
8. Property Name
10. Property Address
12. Tax Map No.
16. B.) Applicant Information (THERE IS NO FEE TO SUBMIT THIS APPLICATION)
18. Property Owner of Record
20. Address
22. Email Address
23. Phone #
25. *Applicant Name
27. Address
29. Email Address
30. Phone #
32. *If applicant is not property owner of record, the Power of Attorney Form is required (Form A-2 from City Plan Review Forms)
36. C.) Licensed Professional (Professional Engineer or Land Surveyor)
38. First Name:
39. Contact Name
41. Address
43. Phone
44. Fax #
46. Email Address:
47. Professional License #
51. Select Grounds for Adjustment Below

    1. Impervious area of the property was measured incorrectly
    2. The property is exempt under the provisions of the ordinance
    3. There is a mathematical error in calculating the stormwater utility fee
    4. The identification of the property owner invoiced is in error
    5. An approved credit was incorrectly applied

    Click on the box to select
55. D.) Signatures
57. If applicant is not property owner of record, the Power of Attorney Form is required (Form A-2 from City Plan Review Forms).
    Please upload document here
59. By signing below you acknowledge you have given accurate information on this application.
61. Print Name
62. Daytime Phone Number To Contact
64. Signature of Owner, Contract Purchaser, Agent
65. Date
    Date
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field