Water & Wastewater Utility

AUSTIN WATER UTILITY Service Extension Request Application and Fair Notice Form Utility Development Services Division 625 East 10th Street, Suite 715 Austin, Texas 78701 http://www.austintexas.gov/ser

Water Wastewater Project Name: SMART Housing Project Site Address: Zip: Legal Description Lot Block Subdivision Sec # OR Acres of the Survey # Tax Parcel #

Name of Owner (Type or Print) Signature of Owner Date

Name of Applicant (Type or Print) Signature of Applicant Date [If Different than Owner]

Name of Engineer (Type or Print) Signature of Engineer Date

STATE OF COUNTY OF This instrument was acknowledged before me on this the day of , , by

. Printed Name of Signer (Owner)

Notary Public, State of

04/15/2013 Page 1 of 3 Engineer: Firm: Address:

Phone Number: Fax Number: email:

Owner/Developer: Firm: Address:

Phone Number: Fax Number: email:

Have you submitted both Water and Wastewater service extensions? Yes No If not, please explain why it is not necessary:

Feasibility investigation of decentralized wastewater options (required for wastewater SERs only) Due to the proximity of centralized wastewater service and/or the density of this development, decentralized wastewater options were not determined to be feasible. Other (Provide decentralized wastewater feasibility investigation statement in the submitted Engineering Materials)

S.E.R. # (To be created by AWU staff, unless previously assigned): Related Development Cases: Quadrant location number(s): Percent of tract within the City Limits of Austin: Percentage of tract within the Desired Development Zone: Percentage of tract within the Drinking Water Protection Zone: Water pressure zone: Water provider: Wastewater drainage basin: Wastewater provider:

04/15/2013 Page 2 of 3 Proposed Development Intended Use: Single Family Residence, Modular Home, Mobile Home (number of units) Duplex (number of duplexes) Triplex, Fourplex (number of units, e.g. 1 triplex = 3 units) Condo Unit; P.U.D., Apartment Unit (number of units) (6+ Units/Acre to 24 Units/Acre) Condo or Apartment Unit (greater than 24 units per acre) (number of units) Hotel or Motel Room (number of units) Office (total square feet) Office Warehouse (total square feet) Retail, Shopping Center (total square feet) Restaurant, Cafeteria (total square feet) Hospital (number of beds) Rest Home (number of beds) Church (Worship only) (number of seats) Movie Theater (number of seats) High School / Middle School (includes Gym and Cafeteria) (number of students) Elementary School (includes Gym and Cafeteria) (number of students) Other (Specify ) (number of ) LUE Guidance Document Available

Information for the Proposed Service Extension Supporting Calculations and Documentation are required Property Description (acres): Water Utility Requirements: Peak Hour gpm; Peak Day gpm Fire Flow Requirement*: gpm for hours at psi minimum residual pressure Sprinkler Reduction Wastewater Utility Capacity Requirements (Peak Wet Weather Flows with Inflow & Infiltration): gpm Requested City Cost Participation for Water Improvements: $ , based on total construction costs of $ Highest Elevation on the Land to be Served by the SER: above mean sea level Lowest Elevation on the Land to be Served by the SER: above mean sea level

*The Fire Flow Requirement should be based on the International Fire Code. For more information please contact the Austin Fire Department, Engineering Services at 974-0160.

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