California Water Use Declaration Form

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Type of Property

Water Source

Primary Water Use

Estimated Monthly Water Usage (gallons)

Declaration Period

Water Conservation Measures Implemented

Additional Comments (optional)