Water Conservation Rebate Program Application

Important: Read all information on page 2 of this application.	Application FY2018/2019 - 	

1. Applicant Information

Name: 	

Mailing address: 	

City: 	State: 	Zip: 	

Property address where fixtures are installed: 	
(If different than mailing address)
Telephone: ( 	) 	- 	

SLWSD Utility account number (To locate check your water bill): 	

2. Fixture Information (Check All That Apply)

1.6 gallons per flush or less	Shower Head Replacement
(Standard Low Consumption Toilet)	(Standard Low Consumption Shower Head)
$100 Rebate (Max Limit 2)			$10 Rebate (Max Limit 2) Manufacturer:__________________ Date purchased: 		Manufacturer:__________________ Date purchased: 	 Number of toilets replaced: 			Number of shower heads replaced: 	
Was the toilet(s) replaced due to the sale of the	Was the shower head(s) replaced due to the sale of the property?	Yes	No	property?	Yes	No
Purchase price: 	Date installed: 		Purchase price: 	Date installed: 	  Number of toilets in building: 			Number of shower heads in building: 	

3. Your Signature Required

I have read, understand, and agree to the terms and conditions as stated on page 2 of this application. If the applicant is not the owner, the owner signature must accompany the applicant’s signature for legal purposes.
Applicant Signature: ______________________________	Date: __________________________ Property Owner Signature: __________________________	Date: __________________________
Return the completed application and necessary documents to:

Additional Comments:

 	

Inspected By: 			Date:	 Application:	Approved	Denied
Rebate Approved By: 		Date:	 Total Rebate Amount: $ 	
Rebate Processing By: 	Date:  	

Waived

OFFICIAL USE ONLY:
Inspection:	Required

St. Lucie West Services District, 450 SW Utility Drive, Port St. Lucie, FL 34986 FOR MORE INFORMATION OR QUESTIONS CALL (772)340-0220

St. Lucie West Services District Water Conservation Rebate Program
The rebate does not apply to sales tax, seat replacement, fittings, or installation charges.

Rebate Eligibility Requirements

The fixture(s) must be installed at a location served by the St. Lucie West Services District Water Department.

The rebate application must be received by the District within ninety (90) days of the date of purchase, as shown on the sales receipt or itemized plumber’s invoice.

A representative of the St. Lucie West Services District Water Department must be permitted to inspect the property to verify installation.

New construction projects and remodeling projects requiring a building permit do not quality for rebates.

Rebates are available for replacing older, existing toilets that use 3.5 gallons per flush or more.

Rebates are available for replacing shower heads that use 5 gallons per minute or more.

Rebates are limited to two toilets and two heads per household or business for the lifetime of the account.

Refer to Chapter III Section 38 for the complete rules and regulations of the Water Conservation Rebate Program.

Procedure

Complete this form and attach the original sales receipt, or itemized plumber’s invoice showing the date of purchase. Return to the St. Lucie West Services District Water Department for processing.

An on-site inspection by a representative of the St. Lucie West Services District Water Department may be required to verify installation before a rebate is considered for eligibility.

Allow four to six weeks from the date the application was received to obtain a rebate.

This is a program to provide financial assistance to customers wishing to replace higher-water-use toilets and shower heads with water-conserving fixtures in their facility or place of business. Installation of the fixtures is the sole responsibility of the applicant, as is the determination of the adequacy and compatibility of their existing plumbing system. The District assumes no responsibility or liability for any damage that may occur to an applicant’s property as a result of participation in the rebate program. Due to circumstances beyond its control, the St. Lucie West Services District Water Department cannot guarantee that installation of the fixtures will result in lower utility costs.