SOUTHWEST FLORIDA WATER iMANAGEME-NT DISTRICT
CONSUMPTIVE USE PERMIIT



Permit Number:
Application Date':
Expiration Date:


This permit authorizes the permitee named above to withdraw a maximum of

gallons of water per year as shown below:


Withdrawal Point
Latitude ,Longitude Gallons per day Maximum Gallons per day Average











The use of said water is restricted to the use(s) as specified on the
application. Any change in the use of said water will require a new or
a modified permit.

In the event an emergency water shortage should be declared, the District
may alter, modify or declare to be inactive, all or parts of this permit.

An authorized District representative rmay at any reasonable time enter the
property to inspect the facilities and may require that this permit be shcwn.

Additional stipulations may be imposed as listed below:












Authorized signature, Consumptive Use Section Date
Aouthwest Florida Water Management District