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2. Residential customers may request an adjustment of their winter average calculation based on abnormal water consumption during the three months of winter averaging. Winter averaging is calculated on the monthly water consumption for the months of December, January and February with the yearly calculation taking place the beginning of March. This adjustment request must be completed by June 1st following the winter averaging process for the current year. Any applications after this date will not be accepted. The application for an adjustment will be reviewed by staff and final approval is at the discretion of management.
4. First Name*
5. Last Name*
7. Account Number*
9. Property Address*
11. City*
12. State*
13. Zip Code*
15. Country*
16. Period to Be Reviewed*
18. Description of the water event that affected your winter averaging:
20. Include any receipts or other supporting documentation that may substantiate your claim. *

    Forms for your pool can be a pool permit or pool specs from your pool company. If there is a leak, please submit a repair bill.

22. Excusable Usage
24. Did you fill your pool for the first time?*

    1. Yes
    2. No
25. What month did you fill your pool for the first time?
27. How many gallons does your pool hold?
29. Have you completed a leak or large bill adjustment form?*

    1. Yes
    2. No
30. Did you receive an adjustment?*

    1. Yes
    2. No
32. Non-excusable usage: during winter averaging months this year did you do any of the following?

    1. Run your irrigation system for any reason?
    2. Drain/refill your existing pool not related to a leak?

    If yes, this application will be voided.

34. Please read and checkmark each item:

    1. I am personally familiar with all of the matters of fact stated in the application and swear that they are made on my personal knowledge and that they are true and correct.
    2. This application is a government record subject to criminal prosecution for false statements under Chapter 37 of the Texas Penal Code and I certify that this application contains no false statements.
36. E-Signature (First and Last Name)*
37. Date*
    Date
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field