____________________ (FOR LAFCO USE ONLY)SAN BERNARDINO LAFCO APPLICATION FOREXTENSION OF SERVICE BY CONTRACT(A certified copy of the City Council/District Board of Directors resolution or a letter from the City Manager/General Manager requesting approval for an out-of-agency service agreement must be submitted together with this application form.) AGENCY TO EXTEND SERVICE:AGENCY NAME: _________________________________________CONTACT PERSON: _________________________________________ ADDRESS: _________________________________________ _________________________________________ PHONE: _________________________________________ EMAIL: _________________________________________ CONTRACTING PARTY:NAME OF PROPERTY OWNER: _________________________________________ CONTACT PERSON: _________________________________________ MAILING ADDRESS: _________________________________________ _________________________________________ PHONE: _________________________________________ EMAIL: _________________________________________ ADDRESS OF PROPERTY PROPOSED FOR CONTRACT: _________________________________________ _________________________________________ CONTRACT NUMBER/IDENTIFICATION: _________________________________________ PARCEL NUMBER(S): _________________________________________ ACREAGE: _________________________________________ City of ChinoJesus Plasencia, Assistant City Engineer13220 Central AvenueChino, CA 91710(909) [email protected] Properties, LLHirah Sheikh4330 Francis AvenueChino, CA 91710(909) [email protected] Monte VistaChino, CA 91710See attached agreement (Exhibit A) APN: 1014-321-080.71 acres or 30,870 SF Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY)The following questions are designed to obtain information related to the proposed agreement/contract to allow the Commission and staff to adequately assess the proposed service extension. You may include any additional information which you believe is pertinent. Please use additional sheets where necessary. 1. (a) List the type or types of service(s) to be provided by this agreement/contract. ________________________________________________________________________________________________________________________________________________________________________________________________(b) Are any of the services identified above "new" services to be offered by the agency? YES NO. If yes, please provide explanation on how the agency is able to provide the service. ________________________________________________________________________________________________________________________________________________________________________________________________2. Is the property to be served within the agency's sphere of influence? YES NO3. Please provide a description of the service agreement/contract.__________________________________________________________________________________________________________________________________________________________________________________________________________________4. (a) Is annexation of the territory by your agency anticipated at some point in the future? YES NO. If yes, please provide a projected timeframe when it anticipates filing an application for annexation of territory that would include the area to be served. If no, please provide an explanation as to why a jurisdictional change is not possible at this time. ________________________________________________________________________________________________________________________________________________________________________________________________ Public sewer to a single-family residence and two accessory dwelling Refer to the Covenant Agreement to Annex for Sanitary Sewer Connection.Annexation will not occur until a logical block of properties, such as a tractor whole block is ready to annex to the City.
There is an existing 8" sewer (to the south) on Monte Vista Avenue200 feet +/- away from the subject property.Refer to Exhibit A units.
Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY) (b) Is the property to be served contiguous to the agency's boundary? YES NO. If yes, please provide explanation on why annexation to the agency is not being contemplated. ________________________________________________________________________________________________________________________________________________________________________________________________5. Is the service agreement/contract in responseto a threat to the public health and safety of the existing residents as defined byGovernment Code Section 56133(c)? YES NO. If yes, please provide documentation regarding the circumstance (i.e. letter from Environmental Health Services or the Regional Water Quality Control Board).__________________________________________________________________________________________________________________________________________________________________________________________________________________6. (a) What is the existing use of the property? ________________________________________________________________________________________________________________________________(b) Is a change in use proposed for the property? YES NO. If yes, please provide a description of the land use change. ________________________________________________________________________________________________________________________________7. If the service agreement/contract is for development purposes, please provide acomplete description of the project to be served and its approval status.__________________________________________________________________________________________________________________________________________________________________________________________________________________ See response 4(a).
Single-family homeZoning - RD2Not applicable
Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY)8. Are there any land use entitlements/permits involved in the agreement/contract? YES NO. If yes, please provide documentation for this entitlement including the conditions of approval and environmental assessment that are being processed together with the project. Please check and attach copies of those documents that apply: Tentative Tract Map / Parcel Map Permit (Conditional Use Permit, General Plan Amendment, etc.) Conditions of Approval Negative Declaration (Initial Study) Notice of Determination (NOD)/Notice of Exemption (NOE) Department of Fish and Game (DFG) Receipt Others (please identify below) ________________________________________________________________________________________________________________________________9. Has the agency proposing to extend service conducted any CEQA review for thiscontract? YESNO. If yes, please provide a copy assessment including a copy of the filed NOD/NOE and a copy of the DFG Receipt.10. Plan for Service:(a) Please provide a detailed description of how services are to be extended to theproperty. The response should include, but not be limited to, a description of:1) capacity of existing infrastructure, 2) type of infrastructure to be extended or added to serve the area, 3) location of existing infrastructure in relation to the area to be served, 4) distance of infrastructure to be extended to serve the area, and 5) other permits required to move forward with the service extension.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The property owner is building two accessory dwelling units and desires to connect to the City's public sewer. The nearest public sewer is less than 200 feet away +/- (to the south) onSee response 1(b)Monte Vista Avenue.The property owner also desires to connect theprimary residence to the public sewer as well.
Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________(b) Please provide a detailed description of the overall cost to serve the property. The response should include the costs to provide the service (i.e. fees, connection charges, etc.) and also the costs of all improvements necessary to serve the area (i.e. material/equipment costs, construction/installation costs, etc.). (c) Please identify any unique costs related to the service agreement such as premium outside City/District rates or additional 3rd-party user fees and charges (i.e. fees/charges attributable to other agencies). ________________________________________________________________________________________________________________________________________________________________________________________________Not applicable
Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY)(d) If financing is to occur, please provide any special financial arrangement between the agency and the property owner, including a discussion of any later repayment or reimbursement (If available, a copy of the agreement for repayment/reimbursement is to be provided). ________________________________________________________________________________________________________________________________________________________________________________________________11 Does the City/District have any policies related to extending service(s) outside its boundary? YES NO. If yes, has a copy been provided to LAFCO? YES NO. If not, please include a copy of the policy or policies (i.e. resolution, municipal code section, etc.) as part of the application. ________________________________________________________________________________________________________________________________________________________________________________________________CCEERRTTIIFFIICCAATTIIOONNAs a part of this application, the City of Chino agrees to defend, indemnify, hold harmless, promptly reimburse San Bernardino LAFCO for all reasonable expenses and attorney fees, and release San Bernardino LAFCO, its agents, officers, attorneys, and employees from any claim, action, proceeding brought against any of them, the purpose of which is to attack, set aside, void, or annul the approval of this application or adoption of the environmental document which accompanies it.This indemnification obligation shall include, but not be limited to, damages, penalties, fines and other costs imposed upon or incurred by San Bernardino LAFCO should San BernardinoLAFCO be named as a party in any litigation or administrative proceeding in connection with this application.The agency signing this application will be considered the proponent for the proposed action(s) and will receive all related notices and other communications. I understand that if this application is approved, the Commission will impose a condition requiring the applicant to indemnify, hold harmless and reimburse the Commission for all legal actions that might be initiated as a result of that approval.
Refer to Exhibit BNot applicable
Extension of Service by Contract____________________ Application Form (FOR LAFCO USE ONLY)I hereby certify that the statements furnished above and in the attached exhibits present the data and information required for this evaluation of service extension to the best of my ability, and that the facts, statement and information presented herein are true and correct to the best of my knowledge and belief. SIGNED ________________________________ NAME: _____________________________POSITION TITLE: _____________________________DATE: _____________________________REQUIRED EXHIBITS TO THIS APPLICATION: 1. Copy of the agreement/contract.2. Map(s) showing the property to be served, existing agency boundary, the location of theexisting infrastructure, and the proposed location of the infrastructure to be extended.3. Certified Plan for Service (if submitted as a separate document) including financingarrangements for service.Please forward the completed form and related information to: Local Agency Formation Commission for San Bernardino CountySan Bernardino, CA 92415-0490PHONE: (909) 38--Rev: krm 8/19/2015 Jesus PlasenciaAssistant City EngineerJesus Plasencia