City of Corona DWP Business/Industrial/Governmental Variance Request for Increased Water Budget

This form is to request a water budget greater than the standard amount Corona DWP has assigned to your business. If you believe you need an increased water budget based on the criteria listed below, please complete and return this form in its entirety. Variances may be approved for any of the following reasons and are subject to periodic review.

If approved and processed, the variance will be applied to water served and billed in the following month billing. You will be notified in writing or by phone if your request has been approved.

Account Number *

Customer Number *

Business Name: *

Contact Name: *

Service Address *

Type of Business *

Phone: *

FAX Number *

Email *

Best way to contact you: *

Phone

FAX

Email

Mail

I request an increased water budget for the following reason(s). Check all that apply: *

Increased staff size

Increased building size

Increase in the number of plumbing fixtures

Irrigated landscape area greater than Corona DWP estimate

Other Circumstances

Increased Staff Size

Additional employees: *

Current employees: *

Total Employees:

0

Increased Building Size

Additional Square Feet: *

Previous Square Feet: *

Total Square Ft:

0.00

Increase in Number of Plumbing Fixtures

Total new fixtures: *

Type of new fixtures *

Irrigated Landscape Area Greater than Corona DWP Estimate

DWP estimated landscape area: *

Actual landscape area (sq. ft.): *

Please submit a property sketch with dimensions on 8.5” x 11” paper . *

Other Circumstances

There may be instances where an increased budget on a permanent or temporary basis may be appropriate. If you believe that is the case, please provide the details in the space below including a start and end date, and repair date and attach any documentation (receipts for parts purchased/invoices) you may have.

Estimated gallons per day required: *

Reason or explanation: *

Please submit supporting documentation: *

By checking the box below, you indicate that you are authorized to submit this variance request form for the above identified business and that the information provided in this application is true and correct. You further understand that: (i) all variances are subject to verification; (ii) the City may request additional information and/or inspection of the interior and exterior of the premises; and (iii) you may be liable for back charges if the provided information is incorrect . *

I agree