3. CAL APPLICATION FOR SEWER SERVICES
OUTSIDE OF CITY BOUNDARIES
ORNT City of San Bernardino
CITY Community and Economic Development Real Property Section FOUNDED IN 18D 201 N. "E" Street - 3°d Floor, San Bernardino, CA 92418 (909) 384-5366 / [email protected]
This application is hereby submitted to the City of San Bernardino, to initiate proceedings for the connection to the City Sewer System from my property, which is located outside the boundaries of the City of San Bemardino pursuant to established City policies, a copy of which I have received and read, and I understand that a S1,300.00 non-refundable processing fee is due at the time this application is submitted. I further understand that prior to the City submitting an application to the Local Agency Formation Commission (LAFCO), I will be required to deposit any applicable LAFCO fees with the City (or to be paid directly to LAFCO). Additional LAFCO fees may be due at the conclusion of the proceedings, which I will be required to pay. I may request a waiver of these fees from LAFCO, based upon an immediate health and safety issue. In the event that the waiver of all or a portion of the LAFCO fees is granted by LAFCO, the waived amount will be refunded. I also understand that I will be required to execute an "Irrevocable Agreement to Annex" in the event that my property may be subject to Annexation into the City of San Bernardino at some future time, if this application is approved. I further understand that sewer capacity and hook-up fees to the City will be due prior to permit processing. This application is being submitted with the understanding that approval is not guaranteed.
Please submit this application with proof of ownership (Copy of Deed. Title Policy, etc.) along with processing fee of $1.300.00 and plat map showing location of property.
Property Owners): MARCElO DebARROS
Mailing Address: 4694 NORTH F ST.
Property Address: 4644 NORTH F ST. SAN BERNARDINO
CA. 92407
Assessor's Parcel No(s): Tel. No.:
[] Existing Development: [] New Development:
[] Residential (Single Family). No. Bedrooms: 2 [] Residential (Single Family) No. Bedrooms. [ ] Residential (multi-family). Describe:_
[I Residential mule min) Describe: DuelliNG UNIT
[ ] Commercial/Industrial. Describe: [] Commercial/Industrial. Describe:
Note: For new development and/or additions, please provide a copy of the site-plan along with a copy of development permit application, if any, filed with the County of San Bernardino.
N/A
Additional Comments:
[] I request a waiver of LAFCO fees based upon the following health and safety urgency:
Date: NOV 28/2023 hulbluttzu
Signature(s)
FOR CITY USE ONLY
Received on:_ _by:_ _Receipt No.:
Nearest sewer main:
CITY FEES:
Filing: $ 1.300.00 Comments:
Capacity:
Connection:
Inspection:
TOTAL:
Rev. 12/2011
RP 2300022