Fillable Form 1.: CONSUMPTIVE USE PERMIT Minor Individual Supplemental

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Form 1.: CONSUMPTIVE USE PERMIT Minor Individual Supplemental

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Page 1 of 4
Form No. 40C-2.900(2), effective August 2014
Incorporated by reference in 40C-2.900(2), F.A.C
CONSUMPTIVE USE PERMIT
Minor Individual
Supplemental Form
St. Johns River Water Management District
4049 Reid Street • P.O. Box 1429 • Palatka, FL 32178-1429 • (386) 329-4500
Application forms may also be submitted electronically at www.s
jrwmd.com.
SECTION 1 – SITE INFORMATION
1.
Provide a description of this facility.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2.
3.
Submit a map showing:
A. The legal boundaries of the property owned or controlled by the permittee/applicant;
B. Any areas on the property that are being or will be irrigated;
C. All existing and proposed withdrawal and connection point locations. Label all wells, pumps
and connection points so they match the IDs provided in Section IV (Sources of Water) of the
main application form (Form No. 40C-2.900(1), which is incorporated by reference in Rule
40C-2.900(1), F.A.C.);
D. A north arrow and map scale; and
E. Labeled landmarks such as roads and political boundaries.
Site Name Acres
County Parcel Identification Number or
Section, Township, Range
TOTAL
______________
Page2of4
Form No. 40C-2.900(2), effective August 2014
Incorporated by reference in 40C-2.900(2), F.A.C
SECTION 2 – WATER USE INFORMATION
Please complete only the sections that apply to the proposed water use in the application. For
Mining/Dewatering use, please complete Form D, which is incorporated by reference in Rule 40C-
2.900(1)(d), F.A.C.
1. POTABLE
SUPPLY –
Complete Section A or B
A
. If the potable supply component is similar to a water supply utility please submit the Population and
Per Capita Water Use and Water Demand Projections tables from Sections E2 and E3 of Public
Supply -- Form E, which is incorporated by reference in Rule 40C-2.900(1)(e), F.A.C.
B. For all other facilities, such as mobile home parks, campgrounds, facilities as such farming or
industrial operations with potable sanitary needs, etc., provide the requested information in the table
below for the previous five years (including the most recent calendar year), and projected
information, at a minimum of five-year intervals, for the requested permit duration.
Year
Permanent Residential)
Occupancy
(number of persons)
Non-Permanent
Occupancy
(Guests, Employees, etc.)
Historical Projected
2. COOLING / AIR CONDITIONING
Provide a description
of water used in any cooling or air conditioning system including
, the method of
discharge, t
he number of times water is recirculated prior to being discha
rged, and where blowdown
from the cooling system is discharg
ed
.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3. IRRIGATED LANDSCAPE / RECREATIONAL AREAS / GOLF COURSE
Type of Irrigated Area
1
Number of Acres Irrigation Method
2
1
Golf course, turf, shrubs, non-turf planting beds, natural areas, common areas, cemetery, athletic field, tennis court
2
Drip, micro jet, overhead, etc.
Page3of4
Form No. 40C-2.900(2), effective August 2014
Incorporated by reference in 40C-2.900(2), F.A.C
5. CULTIVATED CROPS (includes annual/perennial crops, pasture, hay and sod, etc.)
If crops types are rotate
d annually, list the crop(s) with the higher irrigation needs.
1
If applicable
2
Drip, micro jet, overhead, etc.
If any of the crops listed above are rotated or double- or triple-cropped, describe the rotation or multiple crop
cycle.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
6. NURSERY, FERN AND CUT FOLIAGE
1
Greenhouse, outdoor potted, outdoor in-ground, fern saran, fern hammock
2
Drip, micro jet, overhead, etc.
6. LIVESTOCK
Livestock Type
Average
Number of
Livestock
Site
Name
Crop Type
Earliest
Planting
Date
(mo/day)
1
Latest
Harvest
Date
(mo/day)
1
Irrigation
Method
2
Acres
Irrigated
Well(s) or
Pump(s)
Used for
Irrigation
If Applicable
Freeze
Protection
Method
2
Freeze
Protection
Acreage
Well(s) or
Pump(s)
Used for
Freeze
Protection
Site Name
Nursery
Type
1
Plant Type
Irrigation
Method
2
Acres
Irrigated
Well(s)
or
Pump(s)
Used for
Irrigation
If Applicable
Freeze
Protection
Method
2
Freeze
Protection
Acreage
Well(s) or
Pump(s)
Used for
Freeze
Protection
Page4of4
Form No. 40C-2.900(2), effective August 2014
Incorporated by reference in 40C-2.900(2), F.A.C
7. OTHER
Describe other uses of water not listed above such as race track watering, cement mixing, or any other
general commercial/industrial water use.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
SECTION 3 – REQUESTED WATER USE
1. Complete the requested water use table below. Provide projected water amount for each applicable use
type and the water source(s) associated with the use type.
2. The allocations for irrigation withdrawals are based on the supplemental irrigation requirements for the
type of irrigation and acreages listed. Would you like to request District staff calculate and provide you a
recommended amount of supplemental irrigation water? YES NO 
If no, please provide requested amounts in the table below.
1
Provide the name of the water source. Examples include upper Floridan aquifer, stormwater pond, surficial aquifer, Davis Lake
2
Irrigation and freeze protection
3
Refer to the Applicant’s Handbook for standard water use per animal for livestock.
3. Provide a description of the methodology used to calculate the requested water amounts for each use
type (irrigation model, district calculations, historical use, water budget calculations, other similar facilities,
etc.). For requested potable supply water use, include the per capita water use utilized in the projected
water use calculations. Attach additional sheets, if necessary.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
SECTION 4 – WATER CONSERVATION
Please submit a water conservation plan pursuant to Section 2.2 of the Applicant’s Handbook.
Use Type
Requested Amount and Source(s) of Water (mgy)
Source 1 Name
1
_____________
Source 2 Name
_____________
Source 3 Name
_____________
Potable Supply
Cooling / Air Conditioning
Irrigated Landscape/Recreational
Areas / Golf Course
Cultivated Crops
2
Nursery / Fern / Cut Foliage
2
Livestock
3
Other
Total
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Form 1.: CONSUMPTIVE USE PERMIT Minor Individual Supplemental

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Completed 14 April 2022

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