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2. 
4. Stormwater Rate Appeal Application
6. Account Number*
7. Date*
   Date
9. Email Address*
10. Phone Number*
12. First Name*
13. Last Name*
15. Property Address*
17. City*
18. State*
19. Zip*
21. Qualification for appeal

    1. Incorrect calculation of impervious area
    2. Fees have been assigned for a parcel that I do not own
    3. Property meets exemption criteria
23. Briefly, describe the rationale for this appeal:
25. Supporting Documentation
    Upload, from your computer, or bring in a copy, of at least one of the following:
27. Plot Plan
28. As-Built Drawing
29. Other: Information detailing actual impervious surfaces currently on-site.
31. 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.
33. Please type your name below (this will serve as your signature)*
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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