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Name of Applicant: IJca-.1-4 LuE-ur Cagy w0 <br /> Date Received: t/(9 /tot S' <br /> Grant Request: it,34')(4-41. <br /> HB 04-1365: (Plans) Evaluation Checklist <br /> Applicant Demonstrates: Yes No Comments: <br /> Is the applicant a covered entity? <br /> If answered "no" to the above question, then is it an entity which will <br /> soon become a covered entity? <br /> (Only answer this question if the applicant is NOT currently a <br /> "covered" entity) Did they provide a reasonable engineering estimate <br /> of future annual retail demand for the next 3-5 yrs. , all based on <br /> population projections, building permits, expected new taps, and or <br /> some other creditable information that would show that the entity will <br /> become a "covered" entity <br /> If the applicant is a covered entity, have they fully complied with <br /> HB1051 requirements? <br /> Cover letter with the entities: name, contact information , and a <br /> signature of an individual with the authority to commit the resources <br /> of the entity <br /> Application Requirements: <br /> A written statement from the entity's governing board, stating the <br /> entity's commitment to the "plan" and the implementation of long- ✓ PG <br /> la <br /> term water savings measures and programs (w/authorized signature) <br /> Disclosure of organizational structure/chart <br /> Current retail water demand (metered water use)for each of the past ✓ pc, 2 <br /> five years (in acre ft. or million gallons) <br /> A list of people and/or organizations that will be involved in assisting <br /> with putting the plan together (list of who will be utilizing the grant p `. 2. <br /> money) <br /> Not required, but preferred, Information characterizing past water use <br /> by sector, (e.g. residential, commercial, industrial) and the source (e.g. ✓ Z -1-Afttr ( <br /> surface water, groundwater, etc). <br /> Characterization of the water system: <br /> Current (and if available past) per capita water use for the last five ✓ 126, 2 <br /> years and the basis for this calculation <br /> Past, current, and predicted future population served by the entity, <br /> (and the source of this information) ` PG- bt, z <br /> List estimated water savings goals to be achieved through the <br /> implementation of the "Plan", based on water system, the past ✓ p6. 4 <br /> conservation efforts and the future water needs 4` (06s ` ?'R% <br /> Adequacy, Stability, and reliability of the entity's water system Pc, c, <br /> *to be measured and examined by staff through analysis <br /> Paragraph stating the purpose and the primary features of the entity's <br /> desire to create a water conservation plan <br />