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THIS IS A SAMPLE FORM AND SHOULD BE MODIFIED TO MEET THE <br />NEEDS OF THE PARTICULAR PROJECT/CIRCUMSTANCE <br />[Date] <br />General Manager <br />ABC Water District/Agency/Company <br />123 Main St. <br />Anytown USA, 9xxxx <br />Re: Water Supply Assessment for <br />Dear M(r/s.) <br />Project within the City of <br />We have received an application from [project proponent] for the following project <br />'("Project"): <br />[list applications and briefly describe project] <br />We have consulted with each other and have mutually agreed that your <br />[District/Agency/Company] is a public water system that may provide water service to <br />the Project. We have also mutually agreed that the Project is subject to the water supply <br />assessment requirements of Water Code sections 10910 - 10912. Pursuant to Water Code <br />section 10910, [City/County] requests [District/Agency/Company] to submit a water <br />supply assessment for the Project on or before which is within 90 days of <br />the date of this request. We concurrently request the [District/Agency/Company] to state <br />whether the projected water demand associated with the Project was included as part of <br />the [City's or County's] most recently adopted Urban Water Management Plan. Please <br />contact me to confirm receipt of this request. <br />Thank you for your cooperation in this matter. If you have any questions about this <br />request, please contact me at your earliest convenience. <br />[Name] <br />[Title] <br />REQUEST FOR WATER SUPPLY ASSESSMENT FORM "N" <br />75D-218 <br />