APPENDIX A: REQUEST FOR CONSOLIDATION OF CONTIGUOUS PARCEL WATER QUALITY FEES

I,                                                                     hereby certify and attest that I own the contiguous properties at                                                      , located in the city, also indicated with the following parcel identification numbers. Consolidate these parcel identification numbers to the master parcel identification number and account billed to the address below.

                                                                 Master Parcel No.                                     

                                                                 Billing Address:                                        

As such I acknowledge and accept that I will be charged and will pay in a timely manner all water quality user fees applied under the interim and regular fee schedules according to City Code. I certify and attest

that this information is true and correct under penalty of applicable state and local laws. I request that these water quality accounts be consolidated for the purposes of water quality user fee billing.

Certifier and Applicant                              City Engineer (Witness)

Printed Name:                                                       Printed Name:                              

Signature:                                                             Signature:                                    

Date:                                                                    Date:                                           

(Ord. 2009-2, passed 6-1-2009)