Water Withdrawal Permitting Forms

Agricultural

Contact: Edward Rooks, 229-391-2400

• Agricultural Withdrawal Application
• Agricultural Well Completion Data Form
• Agricultural Well Pump Information Form
• EPD Request For Changes To Agricultural Withdrawal Permit (PDF)
• Notification of Agricultural Water Withdrawal Permit Inactivation Revocation (PDF) [Revised Oct. 2023]
• Flow Meter Approval Form
• Agricultural Water Conservation Plan
• Flint River Basin Irrigation System Certification of Efficiency Form
• Low Flow Plan Guide - Drought Contingency Plan (PDF) [Revised Sep 2022]
• Frost/Freeze Protection Letter of Interest for Flint River Basin
• Application for Frost/Freeze Protection Well in the Flint Conservation Use Area

Municipal and Industrial Surface Water

Contact: Johmar Haye, 470-524-0673

• Industrial Surface Water Withdrawal Application (MS Word) [Revised Nov 2009]
• Municipal Surface Water Withdrawal New Application (MS Word) [Revised Nov 2009]
• Surface Water Monthly Withdrawal Report - Raw Water Intake Data (MS Excel) [Revised November 2015]
• Surface Water Withdrawal Interbasin Transfer Annual Report (MS Excel) [Revised June 2015]
• Surface Water Coosa-Tallapoosa River Basin Withdrawal Interbasin Transfer Monthly Report (MS Excel) [Revised June 2015]
• Water Conservation Progress Report (Surface Water, Municipal Systems) [Revised November 2020]
• Water Conservation Progress Report (Surface Water, Industrial/Other Systems) [Revised November 2020]
• Water Conservation Progress Report (Surface Water, Recreational Turf) [Revised November 2020]
• Guidance:  Water Loss Control Program Template 

Municipal and Industrial Groundwater

Contact: Bill Frechette, 470-524-0567

All Groundwater Permit Applicants Must Complete:

Part A Application - General System Information

• Part A Application Form - General System Information (MS Word) [Revised Oct 2022]

Part B Application - Well Data

• Part B Application Form - Well Data (MS Word) [Revised Aug 2008]

Monthly Groundwater Use Reporting Form Version 3 (MS Excel) [Revised Oct 2022]

Municipal Groundwater Permit Applicants Must Also Complete:

• ​Municipal Water Conservation Plan (MS Word) [Revised Apr 2004]
• Municipal Water System Profile - Water Conservation Plan Characteristics [Revised Apr 2004]
• Water Conservation Progress Report (MS Word) [Revised Nov 2020]
• Guidance:  Water Loss Control Program Template
• Submit a signed copy of HB489 Service Delivery Strategy (from the Georgia Department of Community Affairs)

Industrial Groundwater Permit Applicants Must Also Complete:

• Industrial Water Conservation Plan (MS Word) [Revised Apr 2004]
• 5-Year Water Conservation Progress Report for Industrial facilities [Revised Nov 2020]

Golf Course Groundwater Permit Applicants Must Also Complete:

• Golf Course Water Conservation Plan (MS Word) [Revised Apr 2004]
• Golf Course Water System Profile - Water Conservation Plan Characteristics [Revised Apr 2004]
• 5-Year Water Conservation Progress Report for Golf Course facilities [Revised Nov 2020]