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2. REQUESTER INFORMATION

4. Name*
6. Mailing Address*
8. City*
9. State*
10. Zip Code*
12. Property Address where retrofits will take place (if different from above)
14. Phone Number*
15. Email Address*
17. Are you the property owner or tenant?*

    1. Property Owner
    2. Tenant
18. City Utility Account Number*

22. PROJECT INFORMATION

24. Number of Living Units/Apartments*
26. Number of Toilets in the Building
27. Have toilets been retrofitted to 1.6 gpf or less?

    1. Yes
    2. No
29. Number of Fixtures Being Requeted:
31. Faucet Aerators
32. Showerheads
33. Kitchen Aerators

37. REQUIRED ATTACHMENT

39. Please include the following with your application

    1. Owner's Authorization (if applicable)
41. Upload Required Attachment Here

45. APPLICANT CERTIFICATION

47. Acknowledgements

    1. I certify that I am the owner of record or an authorized representative acting on their behalf, or the tenant with the property owner's consent.
    2. I acknowledge that I have read, understand, and agree to the Turf Replacement Program Terms and Conditions (hereinafter referred to as the "Conditions").
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field