Kittitas County Conservation District

Water Measuring Device Cost Share

APPLICATION FORM

1) Applicant Name
Street Address
Mailing Address
City	State	Zip Code
Contact Person
Day time phone	Email

2) What is the water right number for the diversion or withdrawal? Include whether it is a claim, permit or certificate. Attach a copy of the water permit, certificate or claim, if available.

3) What is the legal description of the diversion or withdrawal, if water right documentation is not attached?

Attach a map of point of diversion or withdrawal and measuring device location clearly showing the location of each relative to

rivers, other surface water and township, range and section lines. Use a copy of the appropriate USGS topographic map unless

another map will clearly show these features.

4) Which Water Resource Inventory Area (WRIA) is the project in? Number

39

5) Are you requesting funds for a source meter? YES      NO                   

6) When would the device be installed?

7) Have you received a metering order from Ecology? YES         NO                         

If yes, provide the Order Number

DE-

8) Are you a participant in the WDFW Cooperative Compliance Program? YES NO

9) Are you a participant in your Conservation District’s  Irrigation Efficiency Program? YES NO

If yes, will the cost of a water measuring device be included in your Irrigation Efficiency grant application? YES NO

10) Are you applying for financial hardship?

11) Provide a project description.

(Include all the appropriate information from instructions; e.g. flow rates, type of device, plans and specifications if available).

12) Provide costs for the measuring devices:

		Cost
Measuring device
Ancillary equipment
Installation –	Labor (hours rate )
Equipment Rental
Contracted Services
Other Costs (attach details)
Total Project Cost

I certify that the information above is true and accurate to the best of my knowledge.

Applicant signature

Position

Date

<>