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2. Customer Information:
4. Name*
5. Address*
7. Phone*
8. Email
10. Applicant Relationship to Property*
    -- Select One --OwnerDeveloperManagerTenant

    If not Owner - Please provide a notarized document showing Owners' consent
11. Upload Notarized Document
13. Owner Name*
14. Address*
16. Phone*
17. Email
19. Designated Recycled Water Supervisor*
20. Phone*
22. Project Description
24. Tax Assessor's Parcel Number(s)
26. Lot Size
27. Meter Location
29. Anticipated Water Demand:
30. Gallons Per Day*
31. Peak Gallons*
    Per Minute
32. Expected Start Date*
    Expected Start Date
34. Applicant Signature*
35. Date*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field