Well Conversion Grant Program

Applicant Information

First Name

Last Name

Business Name (Optional)

Address

Address 2 (Optional)

City

State

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Postal Code

Phone

Email

Confirm Email

Property Information

Assessor's Parcel Number

Address

Address 2 (Optional)

City

State

Choose one Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Northwest Territories Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Postal Code

I acknowledge I have proper authority to submit this application and that I will connect to the municipal water supply system and that I will plug and abandon the well presently serving this property as authorized under the Las Vegas Valley Groundwater Management Program. I further acknowledge that the failure to plug and abandon the well may result in legal and other actions, including, but not limited to, a lien against the property. I also acknowledge that fees paid to convert to the municipal water supply system will be based on procedures, costs, rates, fees, and charges established under the Las Vegas Valley Groundwater Management Program and the service rules and regulations of the municipal water supply provider.