• Applicant will, at his or her sole complete expense, design, install, test and complete the water main extension in conformance with all requirements of the District's Regulations Governing Water Service, Standards and Specifications.

• Applicant will arrange for the installation of the water main extension using competitive bidding procedures by obtaining at least three bids for the work from qualified bidders as approved by the District.  Applicant also will submit to the District for approval all bid requests with supporting documents and plans.

• All costs, including the cost of inspection by the District, will be paid directly by the Applicant.  Applicant also will provide the District with a statement of actual construction costs with proof of payment.

Project Information:

 *

Project Information:

Name	State
Assessor's Parcel Number	City
Address	Zip Code

Brief Description and Purpose of Proposed Water Main Extension:

Brief Description and Purpose of Proposed Water Main Extension:

Proposed Water Main Extension Is For:

 *

Proposed Water Main Extension Is For:

Residential

Commercial

Developer's Engineer:

 *

Developer's Engineer:

Name	Engineer’s Estimated Cost of Extension

Contact Information:

 *

Contact Information:

Name	Street Address
Company Name	City
Office Number	State
Mobile Number	Zip Code
Email Address

I have read the terms, conditions and notices concerning the District’s provision of water service and agree to abide by them, as well as by all applicable rules, regulation and ordinances governing District water service not specifically referred to above.

 *

I have read the terms, conditions and notices concerning the District’s provision of water service and agree to abide by them, as well as by all applicable rules, regulation and ordinances governing District water service not specifically referred to above.

Date	Applicant's Name

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