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CCID Water Conservation Program Application

Please complete the form below to submit your application.

    Date:*

    LANDOWNER INFORMATION

    Landowner Name:*

    Landowner Email:*

    APPLICANT INFORMATION

    Applicant Name:*

    Applicant Email:*

    I am the Tenant:*

    Applicant Mailing Address:*

    City, State, Zip:*

    Applicant Phone Number:*

    List other Agencies funding this project:*

    PROJECT INFORMATION

    Proposed Project Type:*

    Project Location (Address/APN):*

    Acres benefitted by project:*

    AG Well Connection?:*

    CONTRACTOR INFORMATION

    Contractor Name:*

    Contractor Representative Name:*

    Contractor Representative Phone Number:*

    Provide a Cost Estimate and Project Design to: TROSIN@CCIDWATER.ORG

    ADDITIONAL INFORMATION

    Provide any additional information you’d like us to know about your project: