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CITY OF MOSCOW PUBLIC WORKS DEPARTMENT 221 E. 2nd St. Moscow, Idaho 83843 Phone (208) 883-7034 FAX (208) 883-7033 TDD (208) 883 -7019 Water Conservation Ordinance Variance Application Name: Phone Number: Address: Date: form will be emailed) Reason for Request: Dates of Request: to Total Number of Days Requested: Hours During Day Requested to Water: to By signing this document I agree to the terms of this variance and realize that failure to adhere to the above conditions may result in revocation of this variance. Applicant Signature: Date: DO NOT WRITE BELOW THIS LINE FOR OFFICE USE ONLY Approved as Requested Approved with the Following Terms: Dates: to Time of Day: to Other Conditions: Disapproved Reason for Disapproval: Public Works Director: Date: Nichole Baker, Conservation Specialist: Date: [EMAIL REDACTED]