Grass Valley, CA · Nevada County
One-Time Adjustment Application
Property owners use this application to request a one-time water-bill credit for unusually high domestic water usage considered non-beneficial.
What this form is
The City of Grass Valley may grant a one-time adjustment when domestic water usage is unusually large and non-beneficial, and no adjustment has been granted in the last five years. The application asks for the service address, explanation of high usage, leak dates, repair details, and owner information and signature. Submit within two billing cycles of the usage; qualifying credits are calculated using the account’s prevailing usage rate.
Who needs it
Property owners seeking a one-time adjustment for unusually high non-beneficial domestic water usage can complete and submit this application.
How to submit it
Return the completed application to City Hall, 125 E Main Street, Grass Valley, CA 95945. Business customers on Nevada Irrigation District water must first qualify for an NID adjustment and include a copy of NID Form 4-E.2.
About notarization
This application is signed and dated without a notary; business customers on Nevada Irrigation District water must attach NID adjustment Form 4-E.2, with no notarized step stated.
How to submit this form
- 1
Download The Application
Download the One-Time Adjustment Application PDF.
- 2
Complete The Application
Provide the service address, usage explanation, leak dates, repair details, and property owner information and signature.
- 3
Gather Required Attachment
If the service address is a business on Nevada Irrigation District water, first qualify for an NID adjustment and attach a copy of NID Form 4-E.2.
- 4
Submit To The City
Return the completed application to City Hall, 125 E Main Street, Grass Valley, CA 95945, within two billing cycles of the usage.
Frequently asked questions
- Do I need a notary for this application?
- No. The property owner signs and dates this application without a notary. Business customers on Nevada Irrigation District water must include a copy of NID adjustment Form 4-E.2.
- How do I submit the application?
- Return the completed application to City Hall, 125 E Main Street, Grass Valley, CA 95945. If the service address is a business on Nevada Irrigation District water, include a copy of NID Form 4-E.2.
- When must I submit the application?
- Submit it within two billing cycles of the non-beneficial usage. The application says adjustments are limited to usage within the previous two billing cycles.
- What information does the application request?
- It asks for the service address, business name if applicable, explanation of high usage, leak discovery and estimated start dates, repair date and provider, and property owner contact details and signature.
Need something notarized?
This One-Time Adjustment Application doesn’t need a notary — but if you have another Grass Valley form that does, a commissioned online notary can help.