Conservation Assistance Program Water Survey Intake Form

Please note: The water survey takes anywhere from one to two hours to complete. The property owner, account holder, or an authorized site representative must be available to meet with Marin Water staff. If you are a homeowner and work with a gardener or landscape professional, we recommend they are present for the outdoor portion of the survey. If you need immediate assistance or have any questions, please contact us at 415.945.1520 or conservation@marinwater.org. This is not a leak detection service. If you believe you have a leak, please see our DIY Home Water Survey.

Learn about other water- and money-saving customer resources with Marin Water’s Monthly E-News.

"*" indicates required fields

Customer Information

Your water service number can be found on your Marin Water bill. If your number is less than 5 digits, please add leading zeros (e.g. 12 = 00012). If you’re requesting a new service enter “00000.”
Address*

Appointment Information

Three appointment times are offered throughout the day. Surveys generally last 1 to 1.5 hours. Please indicate your preference below. Select all that apply. Upon receipt of your form, a Marin Water representative will call or email you to confirm the appointment day and time.
Monday
Tuesday
Wednesday
Thursday
Friday

Additional Information

Reason for requesting water survey (check all that apply)*
How did you hear about this free water survey? (Check all that apply)*

Disclaimer Information

Applicant agrees to defend, indemnify, and hold harmless Marin Water, its directors, officers, agents, and employees from and against any and all loss, damage, expense, claims, lawsuits, and liability, including attorney fees arising out of or in any way connected with the program, which may be asserted by any person or entity, including Applicant, its agents and employees, but excluding liability arising from the sole active negligence or willful misconduct of Marin Water, its directors, officers, agents, and employees.*