Service Provider Report
Application for Certification of Concurrency Reservation
□ Auburn Water □ Baker Water □ East Milton □ Holt Water □ Laurel Hill Water
□ Milligan Water □ Paxton
□ Destin Water Users □ Ft. Walton Beach □ Mary Esther Water □ Niceville water
□ Seminole Water □ South Walton Utilities
□ Crestview Water □ Okaloosa Water & Sewer
Name of Applicant:___________________________________________________________
This application is for______________residential units and/or________________________square feet of non-
Existing permitted treatment capacity of system as of (date)_________________MGD.
Planned approved capacity expansions currently underway or in annual budget for system as of
Existing capacity + expansions underway as of (date)_________________MGD.
Present usage in MGD of system as of (date)_____________________.
Capacity this proposal will require based on Provider’s LOS (__________MGD) as adopted by the Okaloosa
County Board of County Commissioners in Section 6.14 Levels of Service, Land Development Code (Ordinance
GIVEN THE FOREGOING, THE SERVICE PROVIDER:
□ Verifies that the applicant is in the service area.
□ Can provide service and will reserve__________MGD as of (date)___________________.
□ Can provide service and will reserve__________MGD upon applicant execution of agreement with provider.
□ Cannot provide service.
Service Provider representative