Water Utility Water Permit Application

Water Utility Water Permit Application and Service Agreement

Applicant Information

Project / Site Information

Parcel / Tax ID:

Permit Type and Compliance

Permit Type (check all that apply): Construction Irrigation Industrial Temporary Other

Does this project require environmental review or regulatory permits from other agencies? Yes No

Site plan / drawings
Hydraulic calculations
Environmental permits / approvals
Proof of insurance
Payment or payment authorization

Recitals

WHEREAS, Applicant seeks authorization to use, connect to, or modify water utility facilities for the Project described herein; and

WHEREAS, the Water Utility has authority to issue permits, impose conditions, and collect fees for services and connections in accordance with the Utility's ordinances, rates and regulations; and

WHEREAS, the parties desire to set forth the scope of work, payment terms, and conditions under which the Utility will grant the requested permit and provide related services.

Scope of Work

Payment Terms

Permit Fee Amount: $

Late Payment Fee: percent per month on overdue balances.

Term and Termination

Permit Term Start Date:    Permit Term End Date:

Either party may terminate this permit and agreement for material breach upon written notice and a cure period of days, except where immediate termination is authorized by law or emergency conditions.

Confidentiality

The parties acknowledge that information exchanged under this application and agreement may include business-sensitive or proprietary data. Each party shall hold Confidential Information in strict confidence and shall not disclose it to third parties except (i) as required by law, (ii) to contractors performing obligations under this agreement on a need-to-know basis under binding confidentiality obligations, or (iii) with prior written consent of the disclosing party. Confidential Information does not include information that is or becomes publicly available through no fault of the receiving party.

Insurance and Indemnity

Applicant shall maintain insurance coverage as required by the Utility and provide proof of insurance prior to commencement of work. Applicant agrees to indemnify, defend and hold harmless the Utility, its officers, employees and agents from and against all claims, damages, losses and expenses arising out of Applicant's performance under this permit, except to the extent caused by the Utility's gross negligence or willful misconduct.

Yes No

Representations and Certification

By submitting this application and signing below, Applicant certifies that the information provided herein is true, accurate and complete to the best of Applicant's knowledge; that Applicant will comply with all applicable laws, codes, regulations and Utility conditions; and that Applicant consents to inspections, connection conditions, and monitoring as required by the Utility for permit administration.

Governing Law and Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state of . This document, including any permit conditions attached or incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior negotiations, representations or agreements, whether written or oral.

Additional Terms

Administrative Use Only

Permit Approved: Yes No

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