Service Provider Report POTABLE WATER
Application for Certification of Concurrency Reservation Service Provider: □ Auburn Water □ Milligan Water □ Baker Water □ Paxton North □ East Milton South □ Destin Water Users □ Seminole Water □ Crestview Water □ Ft. Walton Beach □ Mary Esther Water □ South Walton Utilities North/South □ Okaloosa Water & Sewer □ Niceville water □ Holt Water □ Laurel Hill Water
Name of Applicant:___________________________________________________________ Date:_____/_____/_________ Location of Property:_______________________________________________________________________
This application is for______________residential units and/or________________________square feet of nonresidential 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:_______________________________________________ Service Provider representative
Date:______________________________