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2. Use this form if you applied for an Exception to the Alameda County Water District (“District”) Water Shortage Emergency Ordinance (“Ordinance”) and it was denied or was approved with conditions, and you are appealing the decision. You have 15 business days to appeal a denied Exception or to appeal an approved Exception with conditions. Please be specific as to why you believe the appeal should be considered.

4. Please attach a copy of your original Exception application to this Appeal.*
6. Exception Information
8. Tracking #
9. Date Submitted*
11. Approved by ACWD?*
    -- Select One --NoYes, with conditions
13. Reason for Appeal*
17. Applicant Information
19. Name*
20. Business/Organization
22. Water Account Number(s)*
23. Address*
25. City*
26. State/ZIp*
28. Phone Number *
29. Email*
31. Applicant’s relationship to property/site
35. Property Owner Name
36. Property Owner Address
38. Site Name
39. Site Address
41. Phone Number
42. Email

46. By entering my name below, I represent that the statements made and information provided with this appeal are true and correct. If it is determined that information included in this appeal is not true and correct, I understand and agree that the District will deny the appeal or rescind the grant of an exception. I understand and agree that this appeal and all related documents are public records and are subject to public disclosure.

48. Name/Signature*
49. Date*
51. Title
53. For Questions or Concerns

    Please email water.cons@acwd.com or call ACWD's Water Conservation Hotline at 510-668-4218.

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field