Residential Water Budget Variance Form

Santa Margarita Water District Residential Water Budget Variance Request Form
The purpose of this form is to request a variance in water budget. A variance would allow an additional budget of water greater than the standard amount SMWD uses for your single family residence. If you require a variance based on the criteria below, please complete this form and provide the required documents. Variances are subject to periodic review by SMWD. Click here for more information about SMWD's rate structure.
First Name*
Last Name*
Account Number*
Example: 111111-11115
E-mail*
Phone Number*

Area CodePhone Number
Service Address
Street Number*
Street Name*
Street Name Line 2
City*
Mailing Address
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Water Budget Variance Request:

Select all that apply and submit the required documentation.
Additional Residents

Select if you have more than 4 permanent residents.
TOTAL Number of Residents
You must attach proof of residency for ALL household members, not just the additional members over the default value of 4 residents. Proof must be preprinted with current service address. Each additional permanent resident will be allocated 55 gallons of water per day per billing period. Increased budget for additional occupants must be renewed annually from the original date of approval. Notifications will be sent. Proof may be one of the following: Birth Certificate (for children under the age of 18); Driver's License; Lease Agreement; School Records.
Attach Documentation on ALL RESIDENTS:

Upload File(s)
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Additional Landscape Area (Single Family Residence with a lot size > 15,000 sq.ft.)

Single Family Residence with more irrigable area than being budgeted for.
Total square feet of irrigable area
Irrigable area does not include building footprint or hardscape like driveways, patios, or sidewalks
Submit landscape drawings or a sketch showing total square feet of the landscape. Include the surface area of your pool and spa. Do not include the hardscape area (e.g. driveways, patios) as part of the total landscape. Record all dimensions in feet and total area in square feet.
Attach Proof

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Medical Needs

Select if you require additional water for medical needs.
Attach a doctor’s note stating condition requires additional water usage and an estimate of how much per month.
Attach Proof

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Licensed Care Facility

Select if you operate a licensed care facility out of your single family residence.
Total Number of Qualifying Persons Receiving Care
Enter #
Submit a copy of the business license(s) and/or permit(s).
Attach Proof

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Horses/Livestock

Select if you require additional water for horses or livestock.
List below the type and quantity of each type of livestock that requires additional water. You must also provide a copy of a veterinarian bill or some other identifying record for each animal submitted. Please be advised that a site visit may be required to verify.
Attach Proof

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Indoor Domestic Animals Weighing more than 100 Pounds

Select to request a variance for a domestic animal that weighs more than 100 pounds
An additional one half gallons per day per animal up to the maximum number of animals allowed per applicable municipal code can be provided.

Please provide the number of qualifying animals (over 100 lbs) and a copy of a veterinarian bill for each animal identified which proves its weight.
Number of Domestic Animals over 100 Pounds?
Attach Proof

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Other Type of Variance Requested

You request a variance for reason not listed above.
There may be other instances where an increased budget is appropriate. Please provide your request in writing below and attach any supporting documents using the "Upload File(s)" button.
Attach Proof

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Variance Request Confirmation & Submission

Variances are effective the date the request is approved by the District.
I declare, under penalty of perjury, that I am the above account holder and the information contained herein, including supporting documentation and attachments, is complete and accurate. I understand, acknowledge and agree that if a variance is granted, SMWD has the right to enter and inspect the interior and exterior of my property to verify that the conditions or circumstances for which the variance was granted are true and correct. I further understand that I may be liable for back charges if I provide false or misleading information. Knowingly providing false or misleading information for purposes of receiving a variance may be subject to civil and criminal penalties. I agree to notify SMWD within 10 days if any of the conditions or circumstances for which my variance was granted have changed. I understand that all variances are subject to change based on future water conservation requirements.
Signature
Should be Empty:

Santa Margarita Water District Residential Water Budget Variance Request Form

Service Address

Mailing Address

Water Budget Variance Request:

Variance Request Confirmation & Submission