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Stormwater Rate Appeal Application
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Stormwater Rate Appeal Application
Account Number
*
Date
*
Date
Email Address
*
Phone Number
*
First Name
*
Last Name
*
Property Address
*
City
*
State
*
Zip
*
Qualification for appeal
Incorrect calculation of impervious area
Fees have been assigned for a parcel that I do not own
Property meets exemption criteria
Briefly, describe the rationale for this appeal:
Supporting Documentation
Upload, from your computer, or bring in a copy, of at least one of the following:
Plot Plan
As-Built Drawing
Other: Information detailing actual impervious surfaces currently on-site.
Owner Certification Statement
I hereby certify that I own the property and hereby certify by penalty of perjury that the information provided in and with this form is accurate to the best of my knowledge.
Please type your name below (this will serve as your signature)
*
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