Household Population Adjustment

2018 Request for Increased Water Budget due to Household Population Adjustment


This form is for households with 4 or more persons only.


Northern Douglas County Water and Sanitation District

2018 Request for Increased Water Budget due to Household Population Adjustment

This form is for households with 4 or more persons only.


Date: Phone:
Name: NDC Acct #:
Email:
Address:

 

By signing/submitting this form, the applicant certifies the above information and acknowledges that:

  • I am applying or reapplying for an annual increased water budget because the above address is the primary residence for persons.
  • The granting of an increase in Water Budget for this purpose is subject to annual renewal.
  • The information contained in this form is subject to audit. Should an audit be necessary, applicant agrees to provide acceptable documentation of the actual household population. Such documentation my include, but is not limited to, copies of Federal 1040 tax forms, driver's licenses or other records which show proof of residence.
  • If any of the information supplied on this application by the applicant is found to be false, the fees and charges will be adjusted retroactively to the the date of this application and appropriate fees and charges added to the next utility services bill for the address.
  • Applicant understands that water usage in excess of the assigned water budget my result in significantly higher costs as an incentive to use water wisely.

<-- pressing Send is your Electronic Signature

If you would rather mail, please print out this form and send in with your signature at the bottom to:


Northern Douglas County Water and Sanitation District
8390E. Crescent Parkway, Suite 500
Greenwood Village, CO. 80111
303-265-7949 Return fax No. 303-773-2050