Water Availability Request Form

WATER AVAILABILITY REQUEST FORM

This Water Availability Request Form ("Request") is submitted by the Applicant to the Water Provider identified below to obtain a preliminary determination of available potable water capacity and applicable connection requirements for the property described herein. Completion of this Request and payment of required fees is a condition to Provider's initial review; it does not constitute an approval to connect nor a guarantee of long-term capacity.

Recitals

WHEREAS, Applicant Name: seeks confirmation of available water service and estimated connection requirements for the site described below; and

WHEREAS, Water Provider: maintains system capacity and may condition service on engineering review, infrastructure upgrades, or payment of applicable fees; and

WHEREAS, Applicant understands that the Provider's response is a preliminary capacity determination and further submittals, permits, or agreements may be required prior to service connection.

Applicant Information

Property / Service Location

Proposed Use and Demand

Attachments and Supporting Documentation

Applicant must submit all applicable attachments for Provider review. Check attachments submitted:

Payment Terms

Applicant acknowledges payment of the Provider's non-refundable review fee and any required deposit prior to review. Estimated fees are provided below; final fees will be determined following engineering review and issuance of any required development or connection permits.

Payment Schedule: Deposit of due at application; remaining balance due prior to issuance of connection permit. Late payments shall accrue interest at , or the maximum lawful rate if lower.

Term and Termination

This Request remains valid for a period of days from the date of Provider's preliminary response, unless otherwise specified by Provider. Provider's preliminary determination does not obligate Provider to reserve capacity beyond the stated period. Provider may terminate review for failure to provide requested information or payment after providing written notice to Applicant at least days prior to termination.

Confidentiality

All information provided by Applicant shall be treated as non-public to the extent permitted by law. Provider may disclose information to regulatory agencies, consultants, or contractors as necessary for technical review and system planning. Applicant agrees that Provider shall have the right to retain copies of submitted materials even if the Request is withdrawn or denied.

Governing Law; Entire Agreement

This Request and any response by Provider shall be governed by the laws of the state in which the Property is located. Applicant acknowledges that this Request, together with Provider's written response and any fee invoice, constitute the entire understanding between Applicant and Provider regarding the preliminary availability determination and supersede any prior communications or proposals on the same subject.

Certification and Authorization

By signing below, Applicant certifies under penalty of perjury that the information provided on this Request and all attachments is true, complete, and accurate to the best of Applicant's knowledge. Applicant authorizes Provider staff and authorized agents to enter the Property for the purpose of verifying existing facilities, measurements, and system connections, provided reasonable notice is given when practicable.

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