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<br />,)\\.(\00 <br /> <br />j\;alll...orAPPliCHnl:~~~ <br />llale!tc('('in'd: I <br /> <br />=r <br /> <br />AvpllcanIO\,lI1onslrllles: y~ No ("ommen": <br />Thlllitisaco\"CTCltcnlily ,/ <br />If answered "no" to the ahoi:'~ question, then is it an entity which will "" <br />sounbo.:comcllcovcn:dcnlil. / <br />(Only ann\tr Ihl\ qUl"iflnn If Ihl' applicant j, NOT C'ur,..nlly II " <br />"covered"l'nlit)') Did lhcy provide a. ruasonablc cnginc\'lingcslim lite ~ <br />offuturcnnnuulrelaildcmamlfoTlhcnC\13-Syn..allblls\"<.lon <br />populalion proje<:lions, building pcnnilS, CXP\'CIOO new 11lpS, and or <br />some othcrcrcditahle infomlalion thai would show thallhc entity will <br />hCCO:lrnc a "covercd"cnlity <br />Oisclosureoforganinllionalslruclurelchart ./ <br />CUrTcmrclailwlllcrd"mandforem'hoflhcpasllive)'CllTS(inacrcll. ~1Dt \ <br />or million "ullonsl <br />A wril1cn statement from the entity's governing bonnl, Slating the ,/ <br />enlity's enmmitment to the "pIWl" ami the implementalinn o~~ng.tenn <br />water SlI~'in s measures nnd .!!lS!!!ms (wlouthori7,cd si~aturc <br />I NlplkllUOQ I(~quire.llll:nu: - - - <br />Cover teller with lhil!ltities: name, conI act information, and a <br />sign'llun,;ofWl individual with thcnull>ority 10 commit the rcsoureesof ./ <br />thcenlilv <br />Alislofpco.lplcltlldlororgllnizlltinnslhalwi1lbcinvnlvedinassisling <br />wilhplltlinglheplantogelhcr(listofwhowi1lheulili~ingthcgrant ,/ <br />mone <br />~"Il"Cl.llliretl, hut preferrcd, Information characterizing past w~llcr use ,/ <br />bysl'Ctor.(e.g.rcsidefllial.oo:~cn:iat,industrial)andthesoun.:c(e.g. <br />surf;lCcwalcr,lll'Oundwatcr,etc. <br />ChRrRelHI~Rtlon orthe waler s)'stem: <br />CUm..11l (and i!(/Vlli/llh/e pa.st) pereupiln ";uler usc for the last five V' <br />Ivearsulldthebasisforlhisealeulation <br />Pllsl,culTent,amlprcdietcdfuturcpopulalionservedhytheentity,(and V <br />thc$Ourceofthisinfomlation <br />Lislestimated wall't"SJvings lloalstobcachic\'cd through the V ,,,-J.a"t. <br />implementation of the "Plan",hascd on watersysteOl,thc past ,+-. <br />conservatioll elTorls and the futurc water necds <br />Adeqllacy,Stahility, and reliahilityofthccnlily'swatcrsystcm ,/ <br />atuhemcasun:danduammedbv-stalTthrou'hamllvsis <br />Paragmphstatingthcpul'JXI!lCundtheprimaryfeaturcsoflheentity's ,/ <br />dl-sirclocfcateawatereonscrvationnian <br />A lletailed narrative (llescriptinn) of tasks 10 be pcrfonncd with grant <br />monies (rclmcd to the wntereonscrvation plan,anll watereffieieney ,/ <br />melt'ures) .Ia "!lCOI'C of "'ork" can combllle this lIem with the tlmclinc <br />dcscribOObclo"} <br />Statcmcntofa financial need V <br /> <br />liB 04-1365: <br /> <br />Evaluation checklist for OWCIlI) starr <br />