Clearance Request

Webform September 15, 2023

This form is intended to be used to obtain general information.

Information about how EMWD will use your information can be found within EMWD's Privacy Policy.

This form is to request contact regarding clearance for business or for residential property. The completed form will be submitted to the Development Services Department and staff will contact you soon.

Contact information

Contact name: *

Contact phone: *

Contact email: *

Site information

Site address: *

Include city, zip code, and ALL suites to be occupied

APN(s): *

assessor’s parcel number(s)

Type of Clearance

Clearance for Businesses (Tenant Improvement, Change of Ownership, etc.)

Clearance for Residential Property

Clearance for Business

Business name: *

applying for permit/occupancy

Type of business/use of space: *

list all uses that apply, i.e. office, warehouse, etc.

Exact square foot of occupied space: *

For multiple use areas or suites, please provide square foot breakdown

Prior business that occupied this space:

Clearance for Residential property

Proposed project type: *

Clearance type:

Water

Sewer

Water connection information:

New/Proposed

Existing

Sewer connection information:

New/Proposed

Existing

Septic

Please specify:

Description of changes/improvements

Other information:

Jurisdictional agency information

Is another agency (City and/or Health) requiring Clearance from EMWD?: *

Yes

Name of agency requiring Clearance from EMWD: *

Provide permit number, if issued:

Are you submitting plans to the agency listed above?: *

Yes

No, plans will be submitted to another agency

Please specify:

Date: *

Electronic Signature: *

By checking this box, I certify that I have completed this form and affirm that I am the contact listed above and the information contained herein, including any and all additional documentation submitted via email, fax or mail, is complete and accurate.