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2. Date:*
   Date:
   Henceforth agreement becomes effective on date and will expire in five years.
4. Property Owners:
6. First Name
7. Last Name
9. First Name
10. Last Name
12. Address:
    Please enter the property address where the rain garden is located.
14. Address
16. City
17. State
18. Zip Code
20. Contact Information:
22. Phone Number
23. Email Address
25. I/we hereby agree that: *

    Checking the boxes and submittal of this form to the James City County Stormwater Division indicates acceptance of the 5-year Rain Garden Inspection and Maintenance Agreement Extension.

    1. I/We will allow James City County and/or VCE to inspect, evaluate, document and photograph the rain garden for an additional 5-years.
    2. I/We understand that the information collected will be used in publicity and educational materials.
    3. I/we will maintain the rain garden for the five-year term in accordance with the Homeowners Guide: Building a Rain Garden.
    4. I/we understand that we may call the VCE office for guidance in performing these tasks 757-564-2170.
    5. I/we will replace plants that have declined or died due to unforeseen circumstances, such as, excessive rainfall, hurricanes, animal damage or periods of drought.
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field