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Certificate of Water Availability

2. Processing Fee: $200
   This Certificate provides information necessary to evaluate development proposals.

   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

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