Title: SWFWMD Consumptive Use Permit Application
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Permanent Link: http://ufdc.ufl.edu/UF00051298/00001
 Material Information
Title: SWFWMD Consumptive Use Permit Application
Alternate Title: SWFWMD Consumptive Use Permit Application (printed)
Physical Description: 6p. printed
Language: English
 Subjects
Spatial Coverage: North America -- United States of America -- Florida
 Notes
General Note: Box 3, Folder 1 ( SWF CONSUMPTIVE USE PERMIT APPLICATION (CUP) FORM ), Item 9
Funding: Digitized by the Legal Technology Institute in the Levin College of Law at the University of Florida.
 Record Information
Bibliographic ID: UF00051298
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: Levin College of Law, University of Florida
Rights Management: All rights reserved by the source institution and holding location.

Full Text




SOUTHWEST FLORIDA WATER MANAGEMENT DISTRICT
CONSUMPTIVE USE PERMIT APPLICATION

5060 U. S. Highway 41, South
Brooksville, Florida 33512
904-796-7211
I

Please TYPE -OR PRINT. Do not use pencil.

1. APPLICANT
(indicate whether: individual dba partnership Corporation other


(address, city, state, zip, telephone w/area code)


LOCAL CONTACT


2. Describe PROPERTY covered by this application: ---
(section, township, range, county)

Indicate to nearest tenth (1/10) acre: owned .leased total

If applicant is not the owner of all the property covered complete the following:

OWNER
(indicate whether: individual dba partnership corporation other


(address, city, state, zip)



ATTACH A COPY OF THE LEASE OR OTHER AGREEMENT WITH THE COMPLETED APPLICATION FORM

3. Is this application for (check one) renewal? yes no or modification of a current Consumptive
Use Permit (CUP)? yes no If yes, give the CUP number

4. The withdrawal of all water covered by this application:

a. Existed prior to January 1, 1975: yes---- no ------ ;

b. Withdrawal began or will begin

c. Both of the above: yes no-----

5. Indicate the number of withdrawal points for this application:

wells streams lakes ponds other (specify) ----

6. What percent (%) of water withdrawn will be used for the following purposes?:

(If "Zero", so indicate)

a. public supply ; b. industrial ; c. irrigation -----;d. individual domestic

supply ;e. other (specify) Total ----- (should equal 100%).


7. Provide breakdown of uses as listed in No. 6; enter percent of total for:

a. Public supply by disposal method: individual septic tank ---%, on site percolation and ponding

%; on site spray irrigation %; off site disposal of treated sewage ---- %;

other (specify) %. Sub-total No. 7a % (should agree with No. 6a above).

b. Industrial: Mining; phosphate %; limerock --sand/gravel ------ other

(specify --

Processing /refining: phosphate ____ %; limerock --%; sand/gravel-- %;

other specifyf) -- %

Perishable food processing --- ------

Power companies (make up) -- -/- ; other (specify) ...-.--.---.. %

Sub-total No. 7b _% (should agree within No. 6b above).









c. Irrigation:

(1) (2) (3) (4) (5)
CROP (list each separately) PERCENT (total ACREAGE METHOD* OPERATION hours
see instruction No.7) withdrawal) s,f, or d day night total













8. Will any part of the water withdrawn, for use other than public supply, as shown in No. 6 above, be disposed

off site? yes no Indicate the total percent so disposed: %


9. Indicate all withdrawal points on the property whether or not they are in use at the present time. Standby,

fire protection, and any other facility not presently in use should show the withdrawal as "Zero'. Proposed

facilities should be treated the same as working facilities but should be shown as "proposed" by notation of the

letter "P".

a. Withdrawal from WELLS: assign a number in column /1/ to each well and enter data for each well in

column /2/ through /5/. The number assigned to each well must agree with the number on withdrawal

sheet (No. 11).

Do not write in this space (1) (2) (3) Withdrawal-jallons/day
(for office use only) No. Diam. Depth Average Maximum
(4) (5)















b. Withdrawal from LAKES, STREAMS, IMPOUNDMENTS, or other SURFACE WATER: Assign a number in

column /1/ for each intake (drop) pipe and enter data for each intake (drop) pipe in columns /2/ through

/5/. The number assigned to each intake (drop) pipe must agree with the number on the withdrawal sheet

(No. 11).

Do not write in this space (1) (2) (3) Withdrawal-gallons/day
(for office use only) No. Diam. Depth Average Maximum
(4) (5)
















I1 additional space is needed, add a separate sheet.






0 0



AFFIDAVIT OF OWNERSHIP FORM


10. List below, as per the following tables, the name and address of each property owner within the prescribed

distance. Encircle the distance as used. The District assumes the responsibility of noticing the list of adjacent

property owners as provided by the applicant.

If water greater then 100,000 gallons per day is to be withdrawn from a well or combination of wells, all property

owners within the following indicated distances from the well, or (at the option of the applicant) from the

property boundary on all sides, must be listed:

Withdrawal amounts Distance Distance from
average gallons/day from Well property boundary

Under 100,000 Notice not required, however, the Affidavit of Ownership form must be marked NA (not appli-
cable) and returned with the CUP application.

100,000 to 500,000 660 feet 100 feet
500,000 to 1,000,000 1, 320 feet 200 feet
1,000,000 and above 2,640 feet 400 feet

If water is to be withdrawn from a body of SURFACE WATER list adjacent owners according to the following
schedule:

Withdrawal amounts Distance Distance from
average gallons/day upstream downstream property boundary

any amount from any impoundment all property owners along the shoreline within
of less than 80 acres 660 feet in each direction

5,000,000 or less 660 1,320 same
over 5,000,000 1,320 2,640 same






















If additional space is needed, add a separate sheet. Failure to list all property owners and their correct addresses
may result in the delayed processing of your application.



Signature of APPLICANT



Signature of OWNER


Include authorization to sign if other than an individual or general partner. Corporation Executive Officer must
sign and affix seal of corporation.






9 O

11. A. WITHDRAWALS) LOCATION
Below is a map of one section of a township divided into 1/4 1/4. Please complete a sketch for every section of property covered by
this application which has one or more withdrawal points (well or intake pipe), showing the exact location of the points as accurately
as possible. Locate all withdrawal points whether or not they are in use if they are covered by this application. Numbers assigned to
these withdrawal points must agree with the numbers shown in item No. 9 on the CUP application form.

If all of the property covered by this application is in one section, sketch the outline of said property on this sheet.

If the property covered by the application is in more than one section, a second section (11B) is included. Additional sections will be
furnished by request to the District. Complete one for each section of property with withdrawal points and also the enclosed PROP-
ERTY LOCATION MAP (item No. 12)



SECTION TOWNSH IP SOUTH RANGE EAST





NW 1/4 of NW 1/4 NE 1/4 of NW 1/4 NW 1/4 of NE 1/4 NE 1/4 of NE 1/4










Nl--WT ./4-- NE---- 1/14
SW 1/4 of NW 1/4 SE 1/4 of NW 1/4 SW 1/4 of NE 1/4 SE 1/4 of NE 1/4











NW 1/4 of SW 1/4 NE 1/4 of SW 1/4 NW 1/4 of SE 1/4 NE 1/4 of SE 1/4











SW 1/4 of SW 1/4 SE 1/4ofSW 1/4 SW1/4ofSE 1/4 SE 1/4ofSE 1/4







20 acres
40 acres 10 acres 5a --







Scale I" 660 feet (1/8 mile)






11. B. WITHInAWAL(S) LOCATION 0 0
Ad-ditional sections will be furnished by request to the District. Complete one for each section of property with withdrawal points and also
the enclosed PROPERTY LOCATION MAP (item No. 12)










SECTION TOWNSHIP SOUTH RANGE EAST








NW 1/4 of NW 1/4 NE 1/4 of NW 1/4 NW 1/4 ot NE 1/4 NE 1/4 of NE 1/4










SW 1/4 of NW 1/4 SE 1/4 of NW 1/4 SW 1/4 of NE 1/4 1/4 of N E 1/4










NW 1/4 of SW 1/4 NE 1/4 of SW 1/4 NW 1/4of SE 1/4 N E 1/4otbh 1/4










4 ...... 'SE 1/4 of SW 1/4- SW7 1/4 t tSb 1/4 ve 1 /4o o 14







40 acres 10 acres 5a _20 acres






Scale 1" 660 ft'i-t (1/8 r:-,;ri












12. PROPERTY LOCATION MAP

Each block in the illustration below represents a section of a township. If the property covered by this application covers more than
one section, please draw a sketch of the property boundaries on this sheet. One section has been divided to show the proportionate
size of a plot. Number the sections to agree with your property. If you need more sections than the sixteen (16) available here, add
a separate sheet with the appropriate illustration thereon.











































640 Acres
(1 Square Mile)

80a
160
20a Acres
40a i






















Scale 1" = 2640 feet (1/2 mile)




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