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CCID Water Conservation Program Application

Please complete the form below to submit your application.

    Date:*

    APPLICANT INFORMATION

    Applicant Name:*

    Applicant Email:*

    LANDOWNER INFORMATION

    Landowner Name:*

    Landowner Email:*

    Mailing Address:*

    City, State, Zip:*

    Contact Telephone:*

    TENANT INFORMATION

    Tenant Name:*

    Tenant Email:*

    Mailing Address:*

    City, State, Zip:*

    Contact Telephone:*

    DETAILS

    Water Source Canal Name:*

    Ditch Name:*

    Irrigation Method:*

    Proposed Project Type:

    Project Location:

    APN:

    Gross Acres:

    AG Well Connection?:

    Material Provided By:

    Installation Provided By:

    Cost Estimate:

    Will you be applying for other funding?:

    If Yes, Provide Agency Name:

    Additional Information: