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Modesto Fire Department FIRE PREVENTION DIVISION 409 12th Street Modesto, California 95354 Tel: (209) 571-5553 Fax: (209) 544-1652 WATER FLOW APPLICATION Date of request: Contact Name: Contact Address: Contact City: Fax: Contact Phone: Contact E-mail: Project name: Project location: Water will be tapped from which street: (to avoid testing the wrong street if there are multiple potential tap locations) In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at FOR FIRE DEPARTMENT USE ONLY Hose Monster: 2½”: 4½”: other: Pitot psi: Static psi: Residual psi: Main size: Static location: Flow location: Time: Flow test date: Flow tested by: PERMIT FEE: $203.00 revised 10/13/21