5.

0
A PPLICATION F ORMS AND
N OTICING R ESOURCES

5.1 A PPLICATION F ORMS

ƒ Instructions and Development Project Application Procedure for Minor Subdivisions
(Tentative Parcel Map) and Standard Subdivisions (Tentative Map)

ƒ Development Project Application

ƒ MPWMD Residential Water Release Form and Water Permit Application

ƒ Water Use & Nitrate Impact Questionnaire

ƒ Water Distribution Permit

5.2 N OTICING R ESOURCES

ƒ APN Map

ƒ Parcels within 300’

ƒ Pre-addressed stamped envelopes

 Monterey Peninsula Water Management District (MPWMD)
5 Harris Court, Bldg. G (PO Box 85)
Monterey, CA 93940
831/658-5600

PRE-APPLICATION FORM
FOR WATER DISTRIBUTION SYSTEM (WDS) PERMITS
Effective September 14, 2005

The information submitted on this form will be reviewed by MPWMD for three general purposes: (1)
determine the type/level of WDS permit needed, (2) notify the applicant of reports, well testing and site-
specific information needed to process a formal application; and (3) query the MPWMD database to identify
and map the location of nearby wells, streams and/or habitats that may be impacted by the proposed system.

Based on the information herein, MPWMD will complete an Application Requirement Checklist to provide
and discuss with the applicant prior to the submittal of a formal application. This Pre-Application process is
intended only to provide general guidance to the applicant based on the preliminary information requested
below. Please note that additional information may be required when the formal application is submitted
and/or during the review and approval of the WDS permit.

Water Distribution System Name: __________________________________________________

Pre-Application Fee: $200; pay to MPWMD when Form submitted to MPWMD
Date Payment and Form Received by MPWMD: _________________________

APPLICANT AND PARCEL INFORMATION

-1. Assessor’s Parcel Number(s) for WDS: 187-521-014, 187-521-015, 187-512-016, 187-512-017,
187-512-018, 187-502-001

2. WDS Site Address and Area: TBD

3. Name of Applicant: The Delfino Family, c/o Alan Delfino

4. Mailing Address: P.O. Box 1812, Aptos, CA 95003

5. Contact Numbers (ph/fax/e-mail): 831.724.7551

6. Agent Name/Contact Information (may include Hydrogeologist): Ben Roeder, RINC Organization,
phone: 831.899.9900, fax: 831.899.9500, email ben.roeder@rincorg.com
Hydrogeologist: Norman Hantzsche, P.E., Questa Engineering Corporation, phone: 510.236.6114,
fax: 510.236.2423

7. Attach Map (8 ½ x 11 or larger): Must include a basic parcel map of the area that shows the parcels
to be served and the approximate location of the wells(s) and/or water supply facilities.

8. Other Attachments (please list attachments, if any): See Application Package Section 9.0 and 10.0
for additional information.

9. _____________________________________________________ ___________________
Signature of Applicant or Agent (Please sign and print name) Date

WDS Pre-Application Form; revised 9/27/05

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 BASIC WATER DISTRIBUTION SYSTEM INFORMATION

10. Please complete the table below by briefly describing both existing and proposed: water sources, land
uses, and water demands on all parcels to be served by the proposed WDS:

WDS Information Existing Proposed

A. Water Source (groundwater, surface
water, reclaimed, desalination, etc.)
B. Cal-Am water service (in Cal-Am
service area? Existing Cal-Am service?)
C. Total number of wells
D. Total number of parcels served
E. Total acreage served (all parcels) acres acres
F. Total number of connections served
(see G and H below)
G. Residential connections (self-
sufficient structure; potable, drinking water
+ associated landscaping)
H. Commercial connections (potable,
drinking water + associated landscaping)
I. Irrigation/agriculture (non-potable) acres acres
J. Expanded Landscape (non-potable) acres acres
K. Live-stock/species (non-potable) head head
L. Other
M. Estimated water use, if known acre-feet per year acre-feet per year
N. Water system infrastructure (tanks,
treatment, backflow, meters, etc.)
Other relevant information, comments or expansion on answers above:

11. Land Use/CEQA Information

□ Zoning and land-use designations for parcels served (from Monterey County or City):
Monterey County General Plan: low density residential, one unit per acre and up to
two units per acre in the Carmel Valley Village Mini Plan (Monterey County 1990).
Zoning: LDR/1-D-S, one unit per acre, Design Control and Site Plan Review

o Permits and approvals required or received from other agencies (e.g., Health
Department (well permit), Planning Department, Building Department, Coastal
Commission, CPUC). Make sure to list any recent or pending subdivisions to be served by
the proposed water system, and include file numbers and resolution numbers used by these
agencies. MPWMD Residential Water Release Form, Water Permit Application, Water Use and Nitrate
Impact Questionnaire, Monterey County Planning and Building Inspection Department Combined
Development Permit, Administrative Permit (non-Coastal), Use Permit, Design
Approval, 30% Slope Variance, Vesting Tentative Map

12. Describe and list previous MPWMD permits received, if any, including permit number and date
issued. Include existing well meter information, if applicable. ______________________________
______________________________________________________________________________

WDSPreAppForm_091205.doc Revised 09/27/05, 4:45 PM WDS Pre-Application Form; revised 9/27/05

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