Rules and Regulations of the State of Georgia

Rules and Regulations of the State of Georgia

Rule 391-3-30 Drought Management

Rule 391-3-30-.08 Variance Requests

Application for a Drought Response Level Variance

(Print or type ALL information)

Applicant Information:

Permittee: / County:
WSID Number(s): / Water Withdrawal Permit Number(s):
Contact Person: / Phone: / Email:
Fax:
Permittee Address:
(No. and Street) (City) (State) (Zip)

Variance Request:

More Restrictive than Current EPD Response Level / Less Restrictive than Current EPD Response Level
Response Level Requested:
(must choose one) / Non-Drought
Level 1 Refer to Rule 391-3-30-.07 for detailed information
Level 2 on drought response levels.
Level 3
Level 3 plus(requires detailed summary of proposed additional restrictions past level 3)
Duration of Requested Restrictions:
Water Source(s):
Self-Supplied Groundwater
Self-Supplied Surface Water (see box below regarding water supply and demand analysis)
Permittees whose principal source of water is surface water must also submit a water supply and demand
analysis worksheet and graph. Link:
Is 25 percent or more of the water supply from storage in or releases from any project owned and operated by
the United States Army Corps?
Purchased Water – any source. Water system purchased from:
A detailed description of why a more or less restrictive drought response level is being requested and justification for the duration of the requested variance must be submitted with this form. A decision will not be rendered until a complete application package and sufficient materials supporting the variance request is submitted. Incomplete application packages will be returned to the applicant for re-submittal.
Complete items below if requesting to impose more stringent restrictions:
Quantity estimate of reduced water use on a monthly basis expected from implementing such restrictions for each
month during which they will be implemented compared to a quantity estimate of reduced water use on a monthly
basis expected from implementing the restrictions otherwise required by Chapter 391-3-30.
Quantity estimate of the effect such restrictions will have upon the permittee's source of water in terms of increased
storage or streamflow available to the permittee for each month during which they will be implemented.

And such other pertinent information submitted by the applicant or required by the Division.

Print or Type Name (authorized representative of permittee)

Sign Name

Title

Date