EXHIBIT 4-B

Lawn Removal and Replacement Rebate Application

Applicant Information

Applicant Name: ________________________________________ ☐ Owner ☐ Tenant

Phone Number: ________________________________ (If tenant, owner’s written authorization must be submitted)

Mailing Address: ___________________________________ City/State/Zip: ________________________

Property Information

Property Type: ☐ Single-Family Dwelling ☐ Multi-Family Dwelling ☐ Non-Residential

Property Address: ___________________________________ City/State/Zip: _______________________

Water Company: _______________________________________ APN Number: _____-_____-_____- 000

Identify area(s) where Lawn exists on Site and specify square footage. Indicate which area(s) will be removed and which, if any will remain. Provide 2-3 photos of each area (photos will not be returned)
☐ Front yard Sq. feet existing Turf Sq. feet to be removed	☐ Left side yard Sq. feet existing Turf Sq. feet to be removed
☐ Back yard Sq. feet existing Turf Sq. feet to be removed	☐ Right side yard Sq. feet existing Turf Sq. feet to be removed
☐ Other: _________ Sq. feet existing Turf Sq. feet to be removed	Total Sq. ft. of Turf to be removed: _____________ Total Sq. ft. of Turf to remain on site: ___________
How is the Turf irrigated now? ☐ Automatic sprinklers ☐ Manual sprinklers ☐ Hand watering ☐ Other ________________

The following items must be included with your application or it will be considered incomplete and denied: ☐ Minimum of 2 years water records ☐ Labeled Site diagram showing all areas of turf

☐ 2-3 photos of each area of the yard ☐ Diagram & description of proposed Lawn replacement

Signature

The Lawn Removal and Replacement Rebate offer is subject to available funding. If funding is not available, applications will be held in order received for future processing. By signing below, the applicant agrees to comply with the program qualifications, as well as all Federal, State and local codes as applicable. The applicant has read, understands and agrees to the terms and conditions and certifies that the information on the application is true and correct.

Applicant Signature: _________________________________________ Date: _____________________

_________________________________________________________________NOTE: In order to complete your application you must contact the District for final inspection and submit copies of your receipts. U:\staff\word\committees\waterdemand\2011\20110204\04\item4_exhB.doc