Placerville Municipal Code Part 1 Project Information Sheet

Date
Project Name	Project Name
Name of Project Applicant	Name of Project Applicant	Telephone No.	Telephone No.
Name of Project Applicant	Name of Project Applicant	Fax No.	Fax No.
Title	Title	Email Address	Email Address
Company	Company	Street Address	Street Address
City	City	State	Zip Code
Project Address and Location:	Project Address and Location:	Project Address and Location:	Project Address and Location:
Street Address	Street Address	Parcel, tract or lot number, if available.	Parcel, tract or lot number, if available.
City	City	Latitude/Longitude (optional)	Latitude/Longitude (optional)
State	Zip Code	Latitude/Longitude (optional)	Latitude/Longitude (optional)
Property Owner or his/her designee:	Property Owner or his/her designee:	Property Owner or his/her designee:	Property Owner or his/her designee:
Name	Name	Telephone No.	Telephone No.
Name	Name	Fax No.	Fax No.
Title	Title	Email Address	Email Address
Company	Company	Street Address	Street Address
City	City	State	Zip Code

Property Owner

"I/we certify that I/we have received copies of all the documents within the Landscape Documentation Package and the Certificate of Completion and that it is our responsibility to see that the project is maintained in accordance with the Landscape and Irrigation Maintenance Schedule."

Property Owner Signature Date

Please answer the questions below:

Date the Landscape Documentation Package was submitted to the City
Date the Landscape Documentation Package was approved by the City
Date that a copy of the Water Efficient Landscape Worksheet (including the Water Budget Calculation) was submitted to the local water purveyor