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SECTION D. WATER CONSUMPTION AND WATER LOSS <br />1. Potable water source(s): <br />❑ ❑ Public system (Specify name) N/A <br />❑ ❑ Private well ❑ Surface water (Specify name of water body) N/A <br />a. Water right permit number: <br />b. Legal description of water source: <br />''/4S, '/4S, , Section, TWN, R <br />2. Potable water use <br />a. Indicate total water use: Gallons per day (average) <br />Gallons per day (maximum) <br />b. Is water metered? ❑ YES ❑ NO <br />3. Supplemental Irrigation water source(s): <br />❑ ❑ Public system or Irrigation District (Specify name) N/A <br />❑ ❑ Private well ❑ Surface water (Specify name of water body) N/A <br />a. Water right permit number: <br />b. Legal description of water source: <br />'/4S, '/4S, , Section, TWN, R <br />ECY-040-179 (rev. 08/2012) Page 7 of 21 <br />