Ful Name (required)

Customer Number (required)

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Service Address

Street Number and Name

City (required)

Postal/ZIP Code (required)

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The purpose of this form is to request a water budget adjustment. An adjustment is an allocation of water greater than what has been calculated for your property. If you require an adjustment based on the criteria below, please complete and return this form. Adjustments are subject to review by Las Virgenes Municipal Water District.

I request an adjustment for the following reason(s) (required)

Change in Number of Permanent Residents

Medical Needs

Horses/Livestock

Licensed Care Facility

Change in Landscape Area

If you are changing your resident count please enter the total number of permanent residents

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If you are changing your budget due to Medical needs attach a doctor’s note stating condition requires additional water usage. If possible, an estimate of the gallons per day needed. Documents can be attached below.

Physicians Note

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If you are requesting a change based on horse or livestock head count, provide a list of the type and quantity of each type of livestock that requires additional water. A site visit may be required for verification

Please enter your livestock list here:

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If you are requesting a change because this service address is a licensed care facility in a residential home, please provide a copy of the business license for this request.

Copy of Business License

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If changes have been made to the landscape area at your property, please provide landscape drawings or a sketch showing the total square footage of landscape area; include the surface area of a pool or spa. Record the dimension in feet and the total area in square feet. House and hardscape should not be included.

Landscape Drawings (Please upload a Zip file if there are multiple documents)

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Adjustments are effective the date the request is received by the District. I affirm that the information contained herein, including the attachments, is complete and accurate. I understand that all adjustments are subject to change based on future water conservation requirements.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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If you are having issues with the online form, open the Water Budget Adjustment Request as a PDF to print and complete, you can return it via email, U. S. Mail or Fax.  Be sure to include documentation for your particular request.

Email:

Customer_Service@LVMWD.com

U.S. Mail:

LVMWD - Water Budget Adjustment Request
4232 Las Virgenes Rd
Calabasas, CA 91302

Fax:

(818) 251-2109