Division of Water Infrastructure

Request for Funding for a S.L. 2023-134 Appropriations Act Directed Project

Request Cyclefield type single line
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Use this form to submit 2023 Appropriations Act Directed Projects Request for Funding to the Division of Water Infrastructure.
Local Government Name*field type drop-down
Select Section 12.2.(e) Line #*field type drop-down
Project Name*field type single line
Please be advised DWI has a 40 character limit for project names.
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County:*field type drop-down
Is this a new S.L. 2023-134 Request for Funding submittal, or are you amending or correcting a previously-submitted Request?”*field type radio button
Is this a new S.L. 2023-134 Request for Funding submittal, or are you amending or correcting a previously-submitted Request?”New SubmittalAmending a previous submittal
Has this project gone out for bid?*field type radio button
Has this project gone out for bid?YesNo
Are you adding money to another funded project?field type radio button
Are you adding money to another funded project?YesNo
Funding Type*field type drop-down
Funding Amount Requested*field type currency
$
Total Project Cost*field type currency
$
PWSIDfield type single line
(If applicable)
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NPDES discharge permitfield type single line
(If applicable)
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Collection System Permitsfield type single line
(If applicable)
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Name of Authorized Representative*field type single line
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Email of Authorized Representative*field type email
Title of Authorized Representative*field type single line
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Mailing Address of Authorized Representative*field type address
Mailing Address 1
Mailing Address 2
City
State / Province / Region
Postal / Zip Code
Country
Name of Request Preparer*field type single line
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Email of Request Preparer*field type email
Organization of Request Preparer*field type single line
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Is the engineer the same as the request preparer?*field type radio button
Is the engineer the same as the request preparer?YesNo
Name of Engineer*field type single line
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Email of Engineer*field type email
Engineering Firm*field type single line
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Name of Person Submitting the Request*field type single line
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Submitter Email:*field type email
Re-Type Submitter Email:*field type email
Completed Request for Funding form*field type file upload
Please keep the file name to 100 characters
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CONFIRMATION OF REQUEST FOR FUNDING SUBMITTAL IS SENT TO THIS EMAIL.
Need to call someone? Contact the Division of Water Infrastructure at 919-707-9160.
Click Submit below when ready, or click Save as Draft if you want to return and complete the request later (it will not be considered complete until you click on Submit). Once you submit an request, you cannot edit your application or files. If you need to make a correction after you submit an request submit a new request and contact the Division.