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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: