Conservation Assistance Program Water Survey Intake Form

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.

Customer Information

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Customer name

Customer number

Address

Address Line 2

City/Town

ZIP/Postal Code

Phone number

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.

Name of person to be present at water survey, if different from account holder

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.

By checking this box I agree to this disclaimer/waiver.