City of Falls Church Application for STORMWATER UTILITY FEE ADJUSTMENT
Property owners must complete the following information for each property requesting an adjustment of their
Stormwater Utility Fee.
Owner:___________________________________________________________________________________
Property Address:__________________________________________________________________________
Parcel ID Number:__________________________________________________________________________
Type of Property (circle one): Single-family home Commercial Faith-based
Multi-Unit Individual Multi-Unit HOA
Contact Individual:_________________________________________________________________________
Phone Number:____________________________________________________________________________
Email:____________________________________________________________________________________
This application is to request a review of the calculated stormwater utility fee for the above property. This re-
quest is being based on the following:
Calculated Impervious Area not representative of calculated conditions
Impervious Area has been removed
Non-compacted gravel or dirt was included in impervious area
Natural, wooded area included
Undeveloped land - a parcel that is without any buildings, structures, or pavement
Other, explain - _____________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Attach to this form any documentation that will assist in determining the impervious area on the above proper-
ty. Please include any additional details that will be beneficial to the appeal review process and submit to the
Director of Public Works. The Director will conduct a review of the appeal and provide a written response
within 30 calendar days.
_________________________________________________________ ________________________
Property Owner Signature Date
click to sign
signature
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