Recycled Water Plan Check Application

"*" indicates required fields

APPLICATION PACKAGE REQUIREMENTS FOR PLAN APPROVAL

REQUIRED: 1 (ONE) CD or flash drive of the first submittal PDF, 2 (TWO) 24 x 36 first submittal drawings, $893 Plan Check Fee made payable to Rowland Water District, New Construction Sites Must Complete Attached Recycled Water Use Permit Application, Cross Connection Plan Approval Application Submitted to The County of Los Angeles-Department of Public Health Bureau of Environmental Protection Cross Connection and Water Pollution Program, Recycled Water User Site Supervisor Training Registration Form Submitted to the Sanitation District of Los Angeles County.

Prior to plan approval, the District must have the following items executed by the Developer:

*Title 22 Engineering Report Fee shall be determined during plan review or may be requested by the County of Los Angeles Department of Environmental Health

APPLICANT INFORMATION

Company Name *

Contact Name *

Company Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone *

Cell Phone *

Email *

PROJECT INFORMATION

Project Name *

Project Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

New Construction or Retrofit *

Recycled Water Use *

I, the [applicant] for this Cross Connection Control Plan Check Application, warrant the truthfulness of the information provided in this application. I understand that typing the name constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Signature of Applicant *

Date

FOR DISTRICT USE ONLY

Check Issued By:

Date

Existing Recycled Water Site (Address)

RWD Customer Rep:

Submittal Fee Paid

File

Max. file size: 200 MB.