• All fields/sections must be filled in.
  • Customer Name, Customer and Account Numbers must match what is shown on your Water Bill.
  • In the "Reason" section mark each item applicable to your case and type your comments in the "Explain" field.
Customer Information
Customer #
(7 numbers only)
Account #
(8 numbers only)
(Click to Validate Customer and Account numbers and Unlock the Form)
Customer Name
(Last Name or Business Name) (First) (MI)
Service Address

(House #, Street Name) (City) (Zip)
Billing Address
(if different)

(House #, Street Name) (City and State) (Zip)
Daytime Phone #
E-Mail
Repeat E-Mail
Meter Size
(select one)

Service Type
(select one)



Reason
I request a relief from compliance for the following reason(s):
a. Any additional reduction in water consumption will result in unemployment
Explain: 
b. Additional members have been added to the household in comparison with 2013
(for water meters 1.5 inches and larger)
Explain: 
c. Larger household with more than four persons (for ¾ and 1 inch meters)
Explain: 
d. Additional landscaping has been added to the property since the corresponding billing period of 2013
Explain: 
e. Changes in vacancy factors in multi-family housing in comparison with 2013
Explain: 
f. Increased number of employees in commercial, industrial, governmental offices in comparison with 2013
Explain: 
g. Increased production requiring increased process water in comparison with 2013
Explain: 
h. Water uses during new construction
Explain: 
i. Adjustments to water use caused by emergency health or safety hazards
Explain: 
j. First filling of a permit-constructed swimming pool
Explain: 
k. Necessary water use for reasons related to illness or health issues for a member of the household
Explain: 
l. Other circumstances not described above.
Explain: 
Additional Comments:

(1000 chars max)  
Upload Supporting Documents
Supporting documents must be in PDF, JPG or DOC(X) format. Max file size: 5 MB each. Select up to 5 documents.
Documents attached to this application will be considered public records. All personal identifiable information (date of birth, social security number etc.) should be redacted from the documents that are attached to this application.
Additional documents can be emailed to drought@dpw.lacounty.gov
Attaching inappropriate or harmful photos or documents will result in rejection of application for relief.


Certification
In order to be considered, an application for relief must be filed with the District within twenty (20) days from the date the provision from which relief is sought becomes applicable to the applicant. No relief shall be granted unless the customer shows that he or she has achieved the maximum practical reduction in water consumption other than in the specific areas in which relief is being sought. No relief shall be granted to any customer who fails to provide any information necessary for resolution of the customer's application for relief. The decision shall be issued within twenty (20) days and provided to the customer.

-Customer Initials(must match First and Last Name)
I certify under penalty of perjury that all the information provided is truthful and correct. I understand that this form is required to be submitted to the Los Angeles County Waterworks Districts, and that all information provided is subject to verification by the District. Supporting documentation (such as photographs, maps, drawings, or other pertinent information) must be attached to the Application, if applicable. The District may request additional information and/or inspect the interior and exterior of the premises. Knowingly providing false or misleading information for the purpose of receiving a relief from compliance with Phased Water Conservation Plan is subject to civil and criminal penalties. By this signature, the Applicant indicates understanding that the application for relief does not guarantee a variance will be granted, and the granting of a relief does not permit waste of water nor non-compliance with any other portion of the Phased Water Conservation Plan.

Customer/Owner Name (Type First and Last Name)
Date
(Type Date as "mm/dd/yyyy" )

If someone assisted Customer to complete this form please provide the contact information below:
Assistant Name:
Phone:
Email:
Repeat Email: