Part 1 — PROJECT INFORMATION SHEET

Date

Project Name

Name of Project Applicant Telephone No.

Fax No.

Title

Email Address Company Street Address City, State

Zip Code

Project Address and Location:

Street Address

Parcel, tract or lot number, if available. City Latitude/Longitude (optional) City, State

Zip Code

Property Owner or his/her designee:

Name Telephone No. Fax No.

Title

Email Address Company Street Address 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:

1. Date the Landscape Documentation Package was submitted to the local agency ________.

2. Date the Landscape Documentation Package was approved by the local agency ________.

3. Date that a copy of the Water Efficient Landscape Worksheet (including the Water Budget Calculation) was submitted to the local water purveyor________.