Project Information Form (PIF)

Indicates required field

Please use this Project Information Form (PIF) to apply for a new water service connection, or upgrade or relocate an existing water meter. If you have questions, please call our Engineering Services Department at 415.945.1530, or email EngineeringServices@MarinWater.org.

(This form is compatible with modern desktop and mobile browsers including Microsoft Edge, Google Chrome, Mozilla Firefox, and Apple Safari.)

Applicant Information

Are you the...

Property Owner

Contractor

Other...

Applicant Contact Information

Applicant Name

Company Name (if applicable)

Applicant Email Address

Applicant Phone

Property Information

Property Owner Name

Property Street Address

City

APN

MMWD Service No.

Building Permit Issued by

Building Permit No.

Project Information

Overall Scope of Work

Type of Work Requested

Meter Size

Existing Improvements (Pre-project)

List all structures with water-using fixtures currently on the property.

Existing Structure #1 Use

sq. ft.

Existing Structure #2 Use

sq. ft.

Existing Structure #3 Use

sq. ft.

Final Improvements (Post-project)

List all structures with water-using fixtures that will be on the property following completion of the project.

Final Structure #1 Use

sq. ft.

Final Structure #2 Use

sq. ft.

Final Structure #3 Use

sq. ft.

Accessory Dwelling Unit (ADU)

Complete this section if your project includes an ADU.

Accessory Dwelling Unit Type

ADU Size (sq. ft.)

Number of bedrooms/bathrooms, ex. 2/1

Owner will live on property?

Fire Protection Information

Fire sprinkler system required?

Dedicated separate fireline connection required?

Dedicated Fireline Connection Size

Fire hydrant(s) required?

Hydrant Make and Model

Fire Department

Fire Dept. Contact Person

Fire Dept. Phone Number

Water-Using Fixtures

Please provide information about your residential or commercial project water-using fixture demand. This will help Marin Water staff determine the minimum meter size. Complete the appropriate table or tables below.

Residential Fixtures

Residential Project?

Residential Fixtures	Number	WSFU	WSFU Total
Kitchen sink	kitchen sink number	ks wsfu	ks wsfu total
Dishwasher	dishwasher number	mst_2_wsfu	mst_2_wsfu_total
Bar sink	bar sink number	mst_4_wsfu	mst_4_wsfu_total
Bathroom sink	bathroom sink number	mst_5_wsfu	mst_5_wsfu_total
Shower	shower number	mst_6_wsfu	mst_6_wsfu_total
Tub/shower combo	tub shower combo number	mst_7_wsfu	mst_7_wsfu_total
Toilet	toilet number	mst_8_wsfu	mst_8_wsfu_total
Bidet	Bidet number	Bidet wsfu	Bidet wsfu total
Lawn sprinkler heads *	lawn sprinkler number	mst_9_wsfu	mst_9_wsfu_total
Washing machine	washing machine number	mst_10_wsfu	mst_10_wsfu_total
Laundry sink	laundry sink number	mst_11_wsfu	mst_11_wsfu_total
1st hose bib (aka spigot to connect a garden hose)	1st hose bib number	mst_12_wsfu	mst_12_wsfu_total
Hose bib additional	mst_13_number	mst_13_wsfu	mst_13_wsfu_total
Total Residential WSFU			mst_grand_total

* Enter the maximum number of lawn sprinkler heads used at one time.

Commercial Fixtures

Commercial Project?

Commercial Fixtures	Number	WSFU	WSFU Total
Bar sink	cmst_1_number	cmst_1_wsfu	cmst_1_wsfu_total
Clinic sink	cmst_2_number	cmst_2_wsfu	cmst_2_wsfu_total
Service sink	cmst_3_number	cmst_3_wsfu	cmst_3_wsfu_total
Kitchen sink	cmst_4_number	cmst_4_wsfu	cmst_4_wsfu_total
Drinking fountain	cmst_5_number	cmst_5_wsfu	cmst_5_wsfu_total
Hose bib (aka spigot to connect a garden hose)	cmst_6_number	cmst_6_wsfu	cmst_6_wsfu_total
Hose bib additional	cmst_7_number	cmst_7_wsfu	cmst_7_wsfu_total
Bathroom sink	cmst_8_number	cmst_8_wsfu	cmst_8_wsfu_total
Urinal	cmst_9_number	cmst_9_wsfu	cmst_9_wsfu_total
Toilet – gravity tank	cmst_10_number	cmst_10_wsfu	cmst_10_wsfu_total
Toilet – flush valve	cmst_11_number	cmst_11_wsfu	cmst_11_wsfu_total
Shower	cmst_12_number	cmst_12_wsfu	cmst_12_wsfu_total
Total Commercial WSFU			cmst_grand_total

Landscape Irrigation

New plantings?

Applies to previously unplanted area without an existing irrigation system.

If "Yes", estimate the area in sq. ft.

Rehabilitated planting area?

Applies to changes made to an existing planted area with an existing irrigation system.

If "Yes", estimate the area in sq. ft.

Cross-Connection Control: Backflow Prevention

Please be advised a Cross-Connection Survey (inspection) will be conducted at this service address to assess potential hazards to the public and internal drinking water systems. Installation of a testable backflow preventer may be required.

The following items must be considered when designing water systems:

Backflow Prevention will affect water and fire protection system(s) pressure.
Backflow prevention is required for all irrigation systems at the point of connection. NOT AT THE METER.
Other hazards such as radiant heat, swimming pools, and water fountains require Backflow Prevention at the supply line.
Backflow Prevention installed at the meter requires the installation of a thermal expansion tank.

If you would like a designated survey date and time, please call 415.945.1488 to schedule an appointment. Otherwise, please select a day of the week and appointment window below.

Day

Appointment Window

8 a.m. - 12 p.m.

12:30 p.m. - 2 p.m.

Contractor Contact Information

Contractor Address

Company

Address

City/Town

State/Province

ZIP/Postal Code

Contractor Phone Number

Contractor Email Address

Job Contact Name

Job Contact Phone Number

Job Contact Email Address

Facility Use

Residential/SFD

Commercial

Commercial/Residential

Other...

Are the following water fixtures or features installed, or will be installed?*

Water Fixture or Feature	Yes	No
Well or Spring	WS-Yes	WS-No
Rain Water Collection	RW-Yes	RW-No
Graywater Collection	GW-Yes	GW-No
Other Source of Water	O-Yes	O-No
Built-in Spa	BS-Yes	BS-No
Carbonator	Carb-Yes	Carb-No
Boiler	Boil-Yes	Boil-No
Radiant Heat	Rad-Yes	Rad-No
Holding Tank	HT-Yes	HT-No

Water Fixture or Feature	Yes	No
Solar Water Heating	SW-Yes	SW-No
Swimming Pool	SP-Yes	SP-No
Cooling Tower	CT-Yes	CT-No
Existing Irrigation	EI-Yes	EI-No
New Irrigation	NI-Yes	NI-No
Water - Heat Exchanger	HE-Yes	HE-No
Pressure Boosting Pump	PB-Yes	PB-No
Water Treatment System	WT-Yes	WT-No
Water Fountain/Feature	WF-Yes	WF-No

Fireline Service Per Marin Municipal Water District Code

Single Source (MMWD)

Private Fire Hydrant(s)

Storage Tank

Auxiliary Water Source

Fire system looped with second fire line

Chemicals used in fire system (anti-freeze, MIC-inhibitors, etc.)

Fireline No. (if applicable)

I agree with this declaration.

I declare under penalty of perjury that all statements herein are true and correct. I understand that a cross-connection survey (site visit) may be performed at the above service address and that backflow prevention requirements may be imposed at any time commensurate with the degree of hazard established by state and municipal laws, regulations, and codes.