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Water Adequacy Determination Application
Purpose & Applicability
To fulfill the water adequacy requirements of the City of Fort Collins (LUC Division 5.17), every development or redevelopment that requires new,
expanded, or Increased water use must provide information related to the ensuring the proposed water supply is adequate for long-term satisfaction
of potable and non-potable water demands of the development, based upon FCMC §26-148 to -150. The Applicant is responsible for familiarity with
applicable code and requirements.
The checklists and requirements below summarize the code; more detail regarding contents of documents and needed information may be found
within the Fort Collins Land Use Code (LUC) and Municipal Code.
Proj ect Information
Project Name: ______ s_te_n_s_o_n_M_in_o_r_S_u_b_d_i_v_is_io_n _____ Project #: ________ _
Project Type: @ Standard Basic Development Review Q Deferral_-_________ _
0 Waiver · Q Change_-________ _
Date of Prior Determination ________ _
Address or Parcel# ______________________________ _
Water Provider
Please SUBMIT a SEPARATE Water Adequacy Determination Application for each water provider that services the development
Established Providers: Fort Collins Utilities Other: -------------
:: OTH ER: Please Provide Contact Information for Water Provider
Manager: _________________ _ Public Water Service Permit #: ------
Email: __________________ _ Phone: _____________ _
Applicant Certification
By submitting these materials and my signature affixed below, I acknowledge my awareness of Land Use Code Division 5.17 regulating the
Determination of Water Adequacy and submit my Request for Review to the City of Fort Collins. I agree to reimburse the City for all costs associated
with reviewing the attached application and associated materials, including costs associated with hiring consu ltants, not to exceed costs directly
attributable to the review [LUC §5.17.5.6(1) and 5.17.6.6(1)). I also acknowledge that this Determ ination may contain conditions, shall be final, and
becomes a material part of all future associated development applications .
Applicant Name (printed): _M_ic_h_a_e_l _G_o_rn_i_k ______________________ _
Email: mg@polestargardens.org ,
Signature: ~£ 7~
Phone : 8084439956
Date: 1 .8.2025
Revised 05/16/2024 281 N Coll ege Ave , Fort Collins, CO 80525 970 .221 .6689 drcoord@fcgov.com Request for Extension 112