Application for Lawn Replacement Rebate
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Applicant
Information |
Applicant Name: ________________________________________ ☐ Owner ☐ Tenant
Mailing Address:
________________________________________________________________
City/State/Zip:
_____________________________Phone Number: ________________________
(If
tenant, owner’s written authorization must be submitted. Owner will be required to sign deed
restrictions.)
|
Property Information |
Property Type: ☐ Single-Family Dwelling ☐ Multi-Family Dwelling ☐ Non-Residential
Property Address: ___________________________________
City: ______________________________Water
Company: ______________________________
APN Number: _____-_____-_____- 000 Is the Lawn irrigated with a well? ☐ Yes ☐ No
|
Identify area(s)
where all Lawn exists on Site and specify square footage. Indicate which
area(s) will be removed and which, if any will remain. Provide 2-3 photos of each area (photos will not be returned) |
|
|
☐ Front yard Sq. feet existing Lawn
Sq. feet to be removed |
☐ Left side yard Sq. feet existing Lawn Sq. feet to be removed |
|
☐ Back yard Sq. feet existing Lawn
Sq. feet to be removed |
☐ Right side yard Sq. feet existing Lawn Sq. feet to be removed |
|
☐ Other: ________________
Sq. feet existing Lawn
Sq. feet to be removed |
Total Sq. ft. of Lawn to be removed: ____________ Total Sq. ft. of Lawn to remain on site: __________ |
|
How is the Lawn irrigated now? ☐ Automatic sprinklers ☐ Manual sprinklers ☐ Hand watering ☐ Other ________________ |
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The following items must be included with your
application or it will be considered incomplete:
☐ Water records (most
recent 2 years) ☐ Labeled Site diagram showing all areas of Lawn
☐ 2-3 photos of each area of the yard ☐ Diagram & description of proposed Lawn replacement
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Signature |
The Lawn Replacement
Rebate offer is subject to available funding. If funding is not available, completed
applications will be held in the order received pending future funding. By
signing below, I agree to comply with the program application process, as well
as Federal, State, and local codes as applicable. I have read, understand
and agree to the terms and conditions set forth in the Lawn Replacement Rebate
Guidelines. I declare under penalty of perjury under the laws of the State of
Applicant Signature:
_________________________________________ Date:
_____________________
NOTE: Prequalified applications are
not deemed complete until the District has conducted a final inspection and
copies of receipts have been submitted. U:\staff\word\boardpacket\2011\20110224\ConsentCal\03\item3_exh3b.doc