Annual Water Use Reporting Form

ANNUAL WATER USE REPORTING FORM

Mail to: Northwest Florida Water Management District, Division of Resource Regulation 152 Water Management Drive, Havana, Florida 32333-9700 ? Telephone: (850) 539-5999

Reporting Period (Year) _____________

Permit Number:

Name of Permittee:

Person providing information:

Street Address:

County:

City:

State:

Zip:

Total net annual acres irrigated:

Irrigation Period: From (Day & Month)

Method of determining water use amounts (check applicable):

Flow Meter

Pump Run Time

Provide any occurrences affecting reported pumping amounts (e.g., equipment malfunctions):

Phone: to (Day & Month)

Other (explain):

Measurement method (check applicable):

Inches per acre

Gallons per month

Other (explain):

System ID. Source of Crop

Net

Total Water Used Per Month

Number

Water

Type

Acres

Jan

Feb

Mar

Apr

May

Jun

Jul

1.

Aug

Sep

Oct

Nov

Dec

2.

3.

4.

5.

Maximum Water Used Within Any 24 Hour Period Per Month

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

6.

Signature:

Telephone Number:

Date:

Total TOTAL

NWFWMD Form #A2-G Effective 7-1-98

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