Forms Center

Certificate of Water Availability

2. Processing Fee: $200
   This Certificate provides information necessary to evaluate development proposals.
4. Permit Number
5. Inside City Limits?

   1. Yes
   2. No
7. Permit Type

   1. Building Permit
   2. Other
   3. Preliminary Plat or PUD
   4. Short Subdivision
   5. Rezone
8. If other, please describe
10. Applicant's First Name
11. Applicant's Last Name
13. Applicant's Phone Number
15. Applicant's Mailing Address
17. City
18. State
19. Zip Code
21. Property Address / Location
23. City
24. State
25. Zip Code
27. Parcel Number
29. Proposed Use
30. Please attach map and legal description
32. Water Purveyor Information
36. 1. Choose select one of the options in this section. Please provide additional information as required.
38. a. Water will be provided by service connection only to an existing (size) water main that is feet from the site.

    1. Yes
40. If yes, what size water main?
41. If yes, how many feet from the site?
45. b. Water service will require an improvement to the water system of

    1. Feet of water main to reach the site
    2. The construction of a distribution system on the site
    3. Other (please describe)
47. If feet of water main to reach the site, how many feet?
48. If other, please describe
52. 2. Choose yes for one option in this section.
54. a. The water system is in conformance with a City/County approved water comprehensive Plan.

    1. Yes
56. b. The water system improvement is not in conformance with a County approved water comprehensive plan and will require a water comprehensive plan amendment.

    1. Yes
60. 3. Choose yes for one option in this section.
62. a. The proposed project is within corporate limits of the City or has been granted Boundary Review Board approval for extension of service outside of the City, or is within the County approved service area of a private water purveyor.

    1. Yes
64. b. Annexation or Boundary Review Board (BRB) approval will be necessary to provide service.

    1. Yes
68. 4. Choose select one of the options in this section. Please provide additional information as required.
70. a. Water is/or will be available at the rate of flow and duration indicated below at no less than 20 pounds per square inch.

    1. Yes
72. Rate of flow

    1. Less than 500 gpm
    2. 500 to 999 gpm
    3. 1000 gpm or more
73. If rate of flow is less than 500 gpm, list approximate gpm
75. Flow test of
76. Calculation of
78. Duration

    1. Less than 1 hour
    2. 1 hour to 2 hours
    3. 2 hours or more
    4. Other
79. If duration is other, please describe
81. Commercial building permits require flow test or calculation
85. b. Water system is not capable of providing fire flow.

    1. Yes
89. 5. Water System has water right certificates or water claims sufficient to provide service.

    1. Yes
    2. No
91. Comments / Conditions
93. Agency Name
95. I hereby certify that the above water purveyor information is true. This certification shall be valid for one year from date of signature.*

    1. Yes
97. E-Signature*
98. Date
    Date
100. Title
Leave This Blank:


102. 1. Receive an email copy of this form.
103. Email address

     This field is not part of the form submission.

104. Submit

* indicates a required field