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THIS IS A SAMPLE FORM AND SHOULD BE MODIFIED AS NECESSARY TO MEET <br />THE 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 Verification for Project within the City/County of <br />Dear M(r/s.) <br />[Subdivision proponent] has submitted to the [City or County] an application for tentative map <br />(No. ## - ##) for the following subdivision ("Subdivision"): <br />[insert project description] <br />[City/County staff has determined that the application is complete. Pursuant to Government <br />Code section 66455.3, we are enclosing a copy of the application.] <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 the <br />Subdivision. We have also mutually agreed that the Subdivision is subject to the water supply <br />verification requirements of the Subdivision Map Act.] Pursuant to Government Code section <br />66473.7(b)(1), [City or County] requests [District/Agency/Company] to submit a water supply <br />verification for the Subdivision on or before , , which is within 90 days of the date <br />of this request. Please contact me to confirm receipt of this request. <br />Thank you for your cooperation in this matter. If you have any questions about this request, <br />please contact me at your earliest convenience. <br />[Name] <br />[Title] <br />WATER SUPPLY VERIFICATION REQUEST FORM "O" <br />75D-219 <br />