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
click to edit
The City of Falls Church is committed to the letter and spirit of the Americans with Disability Act. To request a reasonable
accommodation for any type of disability call 703-248-5030. (TTY 711)
Official Use Only:
Date Received: ____________________________________________________________________________
Reviewed by: _____________________________________________________________________________
Approved? - Yes
No
More information needed: ___________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Currently Billed Impervious Area: _______________________ Square Feet
Revised Impervious Area: _______________________ Square Feet
Please submit this form to:
Department of Public Works
Attn: Stormwater Utility
300 Park Avenue, Suite 100W
Falls Church, VA 22046
Fax - 703-248-5336
Email - jgrey@fallschurchva.gov