Occupancy Adjustment

Indicates required field

Occupancy Adjustment

Only complete this form for households with more than four full-time residents.

Fill out the form below to notify the District of single-family residential water accounts of households with more than four full-time residents. A full-time household resident shall mean an individual who resides at the property served for a minimum of six months of the year. For each full-time household resident, in excess of four, the District will increase the limits on water use by four CCFs per bimonthly billing period. Even if your adjustment is approved, you should continue to conserve water and reduce your usage as much as possible to avoid potential penalties for water use in excess of the limits. Please note that any adjustments made pursuant to this application shall apply from the date the District receives a complete application and no retroactive adjustments will be made.

Applicant Information

Are you a ...? (check all that apply)

Marin Water Account Holder

Property Owner

Tenant

Your Name

Your Phone Number

Your Email

Your Customer Number

Your Service Number

Water Service Address

Street Address

Apartment Number

City

Zip Code

Full-time Household Residents

A full-time household resident is an individual who resides at the property served for a minimum of six months of the year.

Number of full-time residents

Please list the first name, last name and age (optional) of all full-time residents.

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

E-Signature Verification

By checking this box, I certify under penalty of perjury that the information provided is true and accurate.

By checking this box, I acknowledge the following.

I also acknowledge that the District reserves the right to request additional information at any time to determine eligibility for this adjustment and participation in the program can be revoked at any time if a consumer does not meet all qualifying criteria as set forth in the District code. I also acknowledge and understand, the District may at any time modify any or all eligibility criteria, or program components including discontinuing the program, by action of the Board of Directors.