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2. First Name*
3. Last Name*
5. Service Address*
7. Mailing Address*
9. Account Number*
10. Phone Number
12. Email Address
16. I request an increased water allocation for the following reason(s):
18. 1.

    1. Irrigated crop Acreage
20. Instructions
    Please complete the following fields. Be sure to identify each crop type separately and to provide irrigated acreage information for each crop type. *Unirrigated areas (i.e. buildings, driveways, access roads, non-planted areas etc.) should not be included in irrigated area calculations.
22. Crop Type
23. *Irrigated Acreage
24. No. of Trees/Plants
26. Crop Type
27. *Irrigated Acreage
28. No. of Trees/Plants
30. Crop Type
31. *Irrigated Acreage
32. No. of Trees/Plants
34. Total Irrigated Acreage
36. 2.

    1. Livestock
38. Please provide the following information.
40. Livestock Type
41. Quantity
43. Livestock Type
44. Quantity
46. Livestock Type
47. Quantity
49. 3.

    1. Irrigated Decorative Landscape Area
51. Total Decorative Landscape Area in Square Feet**
    **Please include pool surface area in decorative landscape area calculation.
52. 4.

    1. Residents per Household for Ag/Domestic Accounts
54. Total No. in Household
56. 5.

    1. Pools (filled once every five years)
58. Gallons
59. Length (ft.)
60. Width (ft.)
61. Avg. Depth (ft.)
63. 6.

    1. Other Circumstances

    There may be an instance where an increased allocation on a permanent or temporary basis may be appropriate. If you beleive this is the case, please provide the details in the box below and attach any documentation you may have.
65. Details:
67. Attach Documentation (if needed)
69. Electronic Signature*

    1. By checking this box, I have completed this form and affirm that the information contained herein, including any attachments, is complete and accurate.
    2. I further understand that all variance requests are subject to site verification by RCWD staff.
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71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field