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<br /> ,/ 1711 <br /> APPLICATION FOR It'lITIAL REGULAR PERl\1IT For Authority Use Only <br /> AND DECLARATION OF HISTORlCAL USE Date Recieved: - No- <br /> MUNICIPAL AND INDUSTRIAL USERS - Fee Rec'd- County <br /> Edwards Aquifer Authority Code <br /> 1615 No~ St. Marys, PO Box 15830 Review Completed <br /> San AntoniQ; Texas 78212-9030 <br /> (210)222-2204 Fax (210)222-9869 <br /> Toll Free 1-800-292-1047 <br /> General Instructions: Each Applicant for an initial regular permit to withdraw and beneficially use <br /> Edwards Aquifer water from one or more nonexempt wells must complete and file this application and <br /> ~--- Declaration of Historical Use with the Edwards Aquifer Authority on or before December 28, 1996. A <br /> complete Well Information Sheet must be attached for each well covered by the Application and <br /> Declaration. A $25.00 application fee must be paid at the time of filing by cashier's check, personal <br /> check or money order made payable to the Edwards Aquifer Authority. (Cash will not be accepted.) <br /> Section 1 - Applicant(s) Information <br /> . . <br /> Provide the information requested below. If the o\vnerlapplicant is more than one individual with <br /> different residences, attach a written affidavit executed by all interest owners or their legal <br /> representatives describing their respective interests in the welles), listing their names and addresses, <br /> and designating a contact person. If the o\vnerlapplicant is a corporation, partnership, limited <br /> partnership or other business association, state its name and address below and attach \witten <br /> documentation that the Authorized Representative, whose name is provided in. Section 2, is authorized <br /> to represent the o\vner. <br /> Name: City of San Marcos <br /> (Please print or type) <br /> - <br /> Address: 630 East Hopkins <br /> (Street Name and Street No. or Rural Route and Nq.) <br /> Post Office Box No. (if applicable): N/A <br /> I City, State and Zip Code: San Marcos, TX 78666 <br /> I <br /> -- <br /> Telephone No.: Business ls.J.2) ~r:;1-4444 Home L-J <br /> Section 2 - Contact Person or Authorized Representative <br /> Name: Georqe Boeker <br /> (Please prim or type) <br /> Title: Director of Public Works <br /> Relationship to Applicant (agent, officer, attorney in fact) <br /> Address: Same as applicant <br /> (Street Name and Street No., PO Box or Rural Route and No., City, State, Zip) <br /> Telephone No.: Business (512) 393-8010 Home L-J <br /> 1 <br />