Form Center

2. On  December 9, 2021  the  Alameda  County Water  District  (“District”)  declared  a  Water Shortage  Emergency  and  adopted Water Use Regulations,  Restrictions  and  Guidelines ("Ordinance") for  the  water  shortage emergency.   The  Ordinance applies  to  all water  use  in  the  District  including  water from the  ACWD  distribution  system  and  to  all wells,  public  and private,  within  the  District’s service  boundary. An  exception  to  the use restrictions  as  set  forth  in  Section  4(a)  of the Ordinance  must  demonstrate  a  critical need,  and  that  without an  exception  undue hardship  will  result  and/or  health  and safety will  be  compromised.    

   CONDITIONS  TO  GRANT AN EXCEPTION FROM RESTRICTIONS

   Exceptions  are  considered  on  the  basis  of  Section  6  of  the  Ordinance.   Criteria  for  review  of  exceptions  include  the following which  apply  to  both  Residential  and  Non‐residential  customers:

   • Is necessary  to  avoid  any  adverse  effect  on  public  health  or  safety  (e.g.,  accident  and  injury  prevention,  public nuisance  prevention);  OR 
   • Serves an essential  community  need  (e.g.,  sports,  recreation,  child/senior/low  income  services);  OR
   • Is necessary  to  avoid  an  inequitable  and  disproportionately  adverse  impact  (economic  or  otherwise)  upon  the livelihood  of  the  applicant  (e.g.,  job  loss,  income/revenue  loss,  loss  of  investment)  which  would  be  caused  by  the prevailing  level  of  restriction;  OR
   • Would avoid or minimize  appreciable  physical  damage  to  a  building  or  other  structure  owned  or  occupied  by  the applicant;  OR
   • Is necessary  due  to  site  complexity  and  management  issues  (e.g.,  logistics  of  running  all  irrigation  valves  for  a  site  in one  day);  OR
   • Includes  significant  offsets/mitigation  measures  and  demonstrated  water  use  efficiency  measures  are  already  in place.
4. APPLICANT INFORMATION
6. First Name*
7. Last Name*
9. Organization/Business
10. Water Account Number(s)
12. Address 1*
13. Address 2
15. City*
16. State*
17. Zip Code*
19. Phone (primary)*
20. Email*
22. Applicant’s relationship to property/site
26. PROPERTY INFORMATION (if different than applicant information)
28. Property Owner Name
29. Property Owner Address
31. Site Name
33. Site Address 1
34. Site Address 2
36. Site City
37. Site State
38. Site Zip Code
40. Phone
41. Email
45. EXCEPTION REQUESTED

    Please check the appropriate box to indicate the grounds for which you believe an Exception should be granted. Specify reasons below to support your request.

47. Critical Needs

    1. Health and Safety; Accident and Injury Prevention
    2. Community Needs (i.e. sports, recreation, child/senior/low-income services, etc.)
    3. Public Nuisance Prevention/Property Damage/Fire Prevention
49. Adverse Economic Impacts

    1. Loss of Job(s)/Employment
    2. Loss of Revenue/Income
    3. Loss of Investment
51. Implementation Complexities/Issues

    1. Number of Sites/Irrigation Controllers
    2. Adverse Site Conditions
    3. Other (please specify)
53. Mitigation Measures/Offsets

    1. Demonstrated Water Use Efficiencies Already in Place
    2. Proposed New Mitigation Measures to Offset Water Use
55. Detailed Description of Exception Request*

    Describe in detail the exception you are requesting. Please provide clear and specific details about your exception including an estimate of any additional water usage that may result from the request. Details must include: Dates and/or time periods for water usage and estimated duration and quantity of water use. Please carefully review the Ordinance before you make this request, as there are already some exceptions in the ordinance for certain types of water use. Please also provide any offsets or mitigations for additional water use.

57. Reason for Exception Request*

    Describe the reason for the exception request. Note: The reason for an exception to the use restrictions in the Ordinance must demonstrate a critical need, and that without an exception undue hardship will result and/or health and safety will be compromised. Include any supporting documentation to support your request.

59. File Upload

    Please include any supporting documentation to support your request

61. Conditions for Granting Exceptions

    If this exception is granted, I agree to:

    • Adhere to all the specific requirements contained within the exception; 
    • authorize ACWD to publicly disclose this Application Form and all relevant details of the exception;
    • provide appropriate access (as required), to enable ACWD to assess the initial application and monitor the ongoing adherence to any exception conditions; and 
    • any other specified conditions as determined by the District.  

    By submitting this application request, I represent that the statements made and information provided with this application are true and correct. If it is determined that information included in this application is not true and correct, I understand and agree that the District will deny the application or rescind the grant of an exception.

63. Name/Signature*
64. Date*
66. Title

68. Your application will be reviewed and, if deemed complete, you will be notified regarding the status your application within 10 business days. You will have 15 business days to appeal a denied Exception or to appeal an approved Exception with conditions.  Additional  supporting  documents  may  be  required to  review  your  request.  If  approved,  the  exception  will  expire  within  the  time  period  specified  by  the  District  or  one  year from  the  date  of  the  application,  whichever  occurs  first.  It  is  up  to  the  applicant  to  submit  another  request  to  extend  an exception,  if  needed.

70. For Questions or Concerns

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

Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

* indicates a required field