Large Property Variance Application

Name of Applicant (Contact)*

Billing Name (if different)*

Account Holder Address*

Street/Mailing Address for Variance*

Zip code*

Daytime Phone Number*

Email*

Dallas Water Utilities Account Number*

Meter number(s)*

Standard for granting a variance: In order to grant a variance, the Drought Contingency Plan
requires a determination by the Director of Dallas Water Utilities or his or her designee that the
failure to grant the variance will cause an emergency condition adversely affecting the health, safety
or welfare of the public of the person requesting such variance.

Application’s reason(s) to justify granting of a variance based upon the preceding standard:*

Large Property Irrigation System Evaluation Report Form*
Accepted file types: xls, pdf, Max. file size: 200 MB.

If applicable, signed statement by a licensed irrigator indicating that any problems discovered in
Irrigation Evaluation Form have been addressed or repaired

Large Property Irrigation Schedule Form*
Accepted file types: xls, pdf, Max. file size: 200 MB.

with a plan for a 5% monthly water savings for each month in
current year, to be measured using the previous year’s monthly consumption numbers

Reduce water consumption by 5% each month in current year , to be measured using the previous
year’s monthly consumption numbers.

Observe the Water Conservation Ordinance requirements, except that for which the variance
was granted.

If the variance is granted, post the Drought Contigency Plan Variance Permit sign in view of the
public.

The variance will automatically expire with the declaration of an increased Stage of the
Drought Contingency Plan.

Applicant affirms that all statements made and documentation submitted in this Application are true
and correct. Applicant also agrees as part of this Application to comply with all applicable
requirements of Chapter 49 of the Dallas City Code, as amended, including but not limited to,
Section 49-21.1, Conservation Measures Relating to Lawn and Landscape Irrigation.

Applicant understands and agrees that any variance granted may be revoked by the Director of
Dallas Water Utilities at any time in the Director’s discretion if: (a) Applicant violates any terms and
conditions of water usage as set forth above; (b) Applicant violates any of the provisions of Chapter
49 of the Dallas City Code, as amended, including but not limited to Section 49-21.1; (c) the facts or
circumstances that justified the variance no longer exist; (d) an immediate significant reduction in
water supply or waste of water occurs as a result of usage under the variance; or (e) the health,
safety, or welfare of the general public or specific persons requires revocation of the variance.

Applicant has read, fully understands, and consents to the terms and conditions set forth for the
variance, and also understands that violation of the terms and conditions may result in criminal
prosecution in Municipal Court, as well as revocation of the variance permit.

As a further express condition precedent to the granting of a variance as requested by this
Application, Applicant EXPRESSLY AGREES TO FULLY AND COMPLETELY defend,
indemnify and hold the City of Dallas, its officers, agents and employees, harmless against any and
all claims, lawsuits, judgments, costs, and expenses for personal injury (including death), property
damage or other harm for which recovery of damages is sought, suffered by any person or persons,
that may arise out of or be occasioned by Applicant’s violation of any terms or provisions of a
variance permit, if granted, or by any use of water under such a variance permit, REGARDLESS
OF WHETHER OR NOT THE NEGLIENCE, GROSS NEGLIENCE OR COMPARATIVE
FAULT OF CITY, ITS OFFICERS, AGENTS OR EMPLOYEES, CONTRIBUTES IN ANY
WAY TO THE DAMAGE, INJURY OR OTHER HARM MENTIONED ABOVE. THE
REQUIRMENT OF APPLICANT TO DEFEND AS DESCRIBED ABOVE ALSO
UNCONDITIONALLY APPLIES REGARDLESS OF WHETHER OR NOT THE
NEGLIENCE, GROSS NEGLIENCE OR COMPARATIVE FAULT OF CITY, ITS
OFFICERS, AGENTS OR EMPLOYEES, CONTRIBUTES IN ANY WAY TO THE
DAMAGE, INJURY OR OTHER HARM MENTIONED ABOVE. Nothing in this paragraph
shall be construed as waiving any governmental immunity available to the City of Dallas under
Texas law. The provisions of this paragraph are solely for the benefit of Applicant and the City of
Dallas and are not intended to create or grant any rights, contractual or otherwise, to any other
person or entity.

Date

MM slash DD slash YYYY

APPLICANT'S SIGNATURE:*

IF CORPORATE APPLICANT: CORPORATE NAME:

I hereby certify that I have authority to bind the named Corporate Applicant and the Owner of the
Property.

OFFICER’S SIGNATURE :

TITLE: