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Community Managed Open Space License Request Form

Ready to Adopt-A-Lot? Please fill out and submit the form to get started...

Applicant Name* Community Group
(if applicable) Applicant Mailing Address* Applicant Mailing City* Applicant Mailing State* Applicant Mailing Zip* Email Address* Verify Email Address* Phone Number* Requested Address 1* Requested Address 2 Requested Address 3 Requested Address 4 Requested Address 5 Requested Address 6 Is this a renewal? YesNo Nearest Location. (If exact address is unknown, enter nearest intersection and/or closest identifiable address to the lot.)
Proposed use:
Type of water access to be used (i.e. hose, hydrant, rain barrels, etc.)
Access City Water? YesNo
Would you be interested in using water from the City obtaining water from the City for a low fixed rate of $120.00 for the garden season (March 1st thru November 30th)? * denotes required field

The Bureau of Water and Wastewater reserves the right to notify DHCD that water supply will be discontinued within five business days from notice of abuse or misuse at the location previously authorized.

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Community Managed Open Space License Request Form

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