Water Withdrawal Permitting Forms

Agricultural

Contact: Cliff Lewis, 229.391.2410

• Agricultural Withdrawal Application (PDF) [Revised Aug 2008]
• Agricultural Well Completion Data Form (MS Word) [Revised Mar 2008]
• Agricultural Well Pump Information Form (PDF) [Revised Sep 2011]
• EPD Request For Changes To Agricultural Withdrawal Permit (PDF) [Revised Apr 2010]
• Notification of Agricultural Water Withdrawal Permit Relinquishment, Inactivation, or Revocation (PDF) [Revised Jun 2013] *Updated*
• GASWCC Flow Meter Approval Form and Contact Map (PDF) [Revised Nov 2010]
• Flint River Basin Irrigation System Certification of Efficiency Form
• Low Flow Plan Guide - Drought Contingency Plan (PDF) [Revised Jun 2013] *Updated*

Municipal and Industrial Surface Water

Contact: Lebone Moeti, 404.232.7834

• 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 (MS Word) [Revised Aug 2010]

Municipal and Industrial Groundwater

Contact: Bill Frechette, 404.232.7833

All Groundwater Permit Applicants Must Complete:

Part A Application - General System Information

• Part A Application Form - General System Information (MS Word) [Revised Feb 2016]

Part B Application - Well Data

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

Monthly Groundwater Use Reporting Form (MS Excel) [Revised Feb 2016]

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 Aug 2010]
• 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 Mar 2003]

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 Mar 2003]

Updated 02/18/2016