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2. Subdivision
   Please enter the name of your subdivision
3. Does your subdivision have a mandatory homeowners association?*
   -- Select One --YESNO
5. Board President
   Please enter the Homeowner Association President's name
6. Project Contact First Name*
   Please enter the first name of the person responsible for this project
7. Project Contact Last Name*
   Please enter the last name of the person responsible for this project
9. Project Contact Phone *
10. Project Contact Email
12. Address or Location*
    Please provide the address or location where the pet waste station will be placed
13. GPS Coordinates
    Please provide the GPS coordinates of the location where the pet waste station will be placed
14. Picture
    Please attach a picture of the location where the pet waste station will be placed
16. I/we hereby agree that: *

    Checking the boxes, electronically signing and submitting this form to the Stormwater Division constitutes acceptance of the following terms and conditions:

    1. I am an authorized Homeowners Association Board Member or designated representative with approval to acquire a pet waste station from James City County
    2. I acknowledge that the pet waste station will be installed within 60 days of receipt
    3. I will notify residents within the subdivision the location and purpose of the pet waste station
    4. I/we/subdivision will properly maintain the pet waste station to include refilling bags and emptying the container
    5. The pet waste station will be placed in a conspicuous location such as a walking trail, playground, park, or other heavily used area
    6. I/we will notify James City County by calling 757-253-6670 when the pet waste station has been installed
    7. I/we grant James City County permission to inspect the unit
18. Electronic Signature
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field