Date:     Name of Property Owner:

Mailing Information:

Street Address:     City: State:

Zip:     Work Phone:     Fax:     Email:

Legal Description (Include Section, Township and Range)                                        Construction Schedule:

Number of Acres:     Planned Use:     Number of Taps Anticipated:    

Property is Presently Included Into The District: Yes No

Letter Addressee Information: This Will Serve Letter Needs to be sent to? (If different than above)

Name:     Street Address:

City: State:     Zip:

Email:

If you have any questions please call Elizabeth Csotty at 303-682-4694