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					                                           Service Provider Report

                                                POTABLE WATER
                      Application for Certification of Concurrency Reservation

Service Provider:
                                                           North

□ Auburn Water                □   Baker Water      □   East Milton    □   Holt Water   □   Laurel Hill Water
□ Milligan Water              □   Paxton

                                                           South

□   Destin Water Users        □   Ft. Walton Beach           □   Mary Esther Water     □   Niceville water
□   Seminole Water            □   South Walton Utilities
                                                     North/South

□   Crestview Water           □   Okaloosa Water & Sewer


Name of Applicant:___________________________________________________________
Date:_____/_____/_________
Location of
Property:_______________________________________________________________________

This application is for______________residential units and/or________________________square feet of non-
residential usage.

Existing permitted treatment capacity of system as of (date)_________________MGD.

Planned approved capacity expansions currently underway or in annual budget for system as of
(date)___________MGD.

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
91-1).

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.




Signature:_______________________________________________             Date:______________________________
                  Service Provider representative

				
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