2023 High Efficiency Toilet (HET) Candidacy Checklist

Please complete the following*

	Yes	No
Customer receives water from City of Evans
Original Toilet is at or above 1.28 gallons per flush (GPF)
Distance from wall to toilet bolt is 12" min (our new toilets will not fit if the bolts are less than 12 inches from the wall)
I confirm nothing is impeding the toilet above (i.e. handicap bar, counter, shelving, etc) (Our toilet is 30 inches tall from base to top)
I confirm that there is no water damage, gurgling noises, uneven flooring, or unconventional piping coming from toilet

Below are examples of toilets that DO NOT qualify for replacement for either having existing water damage, being less than 12" from the wall, or being equal to or less than 1.28 GPF (as seen in order below).
What shape toilet would you prefer? (LCCC can not guarantee that you will receive your preferred toilet shape)

RoundElongatedNo preference
What level will the toilet be installed on?

Ground/Main floorBasement2nd story floor3rd story floor
Please upload a picture of the toilet you would like to be replaced. Make sure the floor around the toilet is visible in the photo. *

Browse Files

Cancelof
Additional Notes on HET Install

Verification
By signing below, I acknowledge that I have filled out the High Efficiency Toilet Candidacy Checklist to the best of my ability and understand that when the Larimer County Conservation Corps crew arrives on the day of my assessment, they may deem that my toilet does not qualify for replacement due to the aforementioned qualifications. I understand that completing this form does not guarantee my eligibility for a free High Efficiency Toilet.
Verification Signature*

Clear
Once you have sumbitted this form, please call the Larimer County Conservation Corps office at (970) 498-6660 to learn more about scheduling.
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High Efficiency Toilet (HET) Candidacy Checklist Form