1

Please provide contact information for the individual or business applying for a Certificate of Water Availability.

 *

Please provide contact information for the individual or business applying for a Certificate of Water Availability.

Name

Street Address

Please provide contact information for the individual or business applying for a Certificate of Water Availability.

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code

Phone Numberext.

Email Address

2

Please provide contact information for the individual or business who owns the property for which the Certificate of Water Availability would apply. (You may leave this section blank if the contact information is the same as above.)

Please provide contact information for the individual or business who owns the property for which the Certificate of Water Availability would apply. (You may leave this section blank if the contact information is the same as above.)

Name

Street Address

Please provide contact information for the individual or business who owns the property for which the Certificate of Water Availability would apply. (You may leave this section blank if the contact information is the same as above.)

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code

Phone Numberext.

Email Address

3

Please provide location information for the proposed development project. 

 *

Please provide location information for the proposed development project.

Street Address

Please provide location information for the proposed development project.

Parcel Number

4

Please indicate the type of project this Certificate would apply to:

 *

Please indicate the type of project this Certificate would apply to:

Commercial/Industrial

Residential, Multi-family

Residential, Single-family

Mixed Use

5

Residential and mixed use projects. Please answer the following question:

How many individual living units are proposed?

6

Commercial/Industrial projects. Please answer the following questions:

Commercial/Industrial projects. Please answer the following questions:

Describe the proposed water uses at this location.

Estimate water use in gallons per day.

How many days per week will this facility be open?

Please provide any additional information that will help us estimate how much water this project will use on a daily basis once completed. Include estimated volume of water and locations of use inside and outside of buildings, such as irrigation, number of bathroom, kitchens, persons using facilities, etc.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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