"*" indicates required fields

Date * Required
Is There An Existing Recycled Water System?
If “No,” Expected Start Date

Email * Required

Pursuant to Ordinance No. 0-8-2010 approved by the Board of Directors of the Rowland Water District Establishing Mandatory Recycled Water Connection Policy, “Permittee,” hereby makes application for the use of recycled water under the following terms and conditions
1. Purpose for which recycled water will be used: (Check all the apply)
Permittee shall comply with Ordinance No. 0-8-2010 of the District’s Rules and Regulations Governing Recycled Water Service and the California, Department of Public Health regulations (Title 22) regarding cross-connections and the use of recycled water.
The facilities described herein shall be constructed and maintained according to District standards by the owner of the property served.
Permittee shall provide the District, prior to rendering recycled water service to the facilities described herein, a complete set of “as built” plans showing new installations or modifications to the following with respect to the potable or recycled water systems
Check Applicable Box
Permittee designates the following person as “Site Supervisor,” having complete working knowledge of the system and delegated responsibility for ensuring the proper use of on-site recycled water service. Permittee also agrees to notify Rowland Water District of any change in “Site Supervisor” designation. (Proof of “Recycled Water Users Site Supervisor Training” must be emailed to info@rwd.org for this application to be complete.)
Permittee agrees to allow the District periodic access to his/her facilities during reasonable hours for the purpose of inspecting the Permittee’s system for compliance with District Standards for Recycled Water Use.
Permittee shall hold the District, its officers, agents and employees free and harmless from any cost, liabilities, or damages (including attorney’s fees) which may arise or are claimed to have arisen as a result of any act or omission to act, including any negligent act or omission to act by Permittee or on behalf of Permittee with respect to the construction, installation, operation, or repair of recycled water and related facilities.
Prior to commencement of service, Permittee shall pay to the District, all applicable fees and service charges in effect as of the date of issuance of the permit of said service.
Permittee shall not change or modify the approved on-site potable or recycled water distribution systems without prior written approval of the District. If Permittee changes or modifies the approved system or fails to maintain the approved system in a state of good repair, the District may, in addition to its other legal remedies, terminate recycled water service.
PLEASE NOTE. This application will not be considered complete until the following support material is emailed to info@rwd.org: 1. PROOF OF RECYCLED WATER USERS SITE SUPERVISOR TRAINING 2. IRRIGATION CONTROL MAP 3. COPY OF EMERGENCY CROSS-CONNECTION RESPONSE PLAN
Terms and Conditions * Required