Water Connection Application

2. IMPORTANT NOTE: Prior to submittal of a Water Connection Application, the applicant must read the Water Connection Guidelines.

   The applicant shall: <br> <ul> <li> Complete and submit the Water Connection Application below. </li> <li> Attach a copy of the stamped and approved Menlo Park Fire Protection District (MPFPD) plans. </li> </ul> <br> The City shall review the application and plans submitted, and the following steps will occur: <br> <ul> <li>The City will begin the process of determining appropriate fees for the requested connections. </li> <li>If the water service line will be replaced, the owner shall hire a Class A contractor to perform the work within the public right-of-way. The contractor shall obtain an encroachment permit and fulfill all permitting requirements with the City. </li> <li>Once fees are determined, the City will send a fee invoice to the applicant for payment.</li> <li>The applicant shall pay the fee at City Hall (address below). Bring a copy of the fee invoice with you.</li> </ul> <p style="margin-left: 10%">City of Menlo Park</p> <p style="margin-left: 10%">City Hall (front counter)</p> <p style="margin-left: 10%">701 Laurel St., Menlo Park, CA 94025</p> <p style="margin-left: 10%">650-330-6704</p> <p style="margin-left: 10%">Front counter: Deposit to 861-20601-1791</p> <ul> <li> Once we receive payment, the City will authorize the work and provide applicable contact information.</li> </ul>

   The applicant shall:
   

   • Complete and submit the Water Connection Application below.
   • Attach a copy of the stamped and approved Menlo Park Fire Protection District (MPFPD) plans.

   
   The City shall review the application and plans submitted, and the following steps will occur:
   

   • The City will begin the process of determining appropriate fees for the requested connections.
   • If the water service line will be replaced, the owner shall hire a Class A contractor to perform the work within the public right-of-way. The contractor shall obtain an encroachment permit and fulfill all permitting requirements with the City.
   • Once fees are determined, the City will send a fee invoice to the applicant for payment.
   • The applicant shall pay the fee at City Hall (address below). Bring a copy of the fee invoice with you.

   City of Menlo Park

   City Hall (front counter)

   701 Laurel St., Menlo Park, CA 94025

   650-330-6704

   Front counter: Deposit to 861-20601-1791

   • Once we receive payment, the City will authorize the work and provide applicable contact information.

4. Water Connection Guidelines

   Water Connection Guidelines

5. I have read and understood Water Connection Guidelines*

   1. Yes

7. Service address*

9. Name (First, Middle, Last)*

10. Phone number*

11. Email address*

13. Other contact name

14. Phone number

15. Email address

17. Water billing mailing information (check one):*
    -- Select One --Send the water bill to the service address provided above.Send the water bill to the mailing address shown below.

19. Mailing address*

21. Type of service (select one)*

    1. Residential
    2. Commercial
    3. Industrial

    1. Irrigation
    2. Fire

22. Residential fire service - applicant will install (select one)*

    1. Passive-purge fire sprinkler system
    2. Backflow prevention assembly

24. If you will be replacing the service line between the water main and meter*

    1. I acknowledge that I must hire a class A contractor who will be responsible for obtaining an encroachment permit and complying with all permitting requirements of the City.

26. Please upload all applicable plans (MPFPD sprinkler plans, site utilities plans, irrigation plans, etc.)*

28. For more information regarding this application, please contact <a href=/directory.aspx?EID=91 target="_self" class="Hyperlink">Assistant Engineer Eric Hinkley</a>.

    For more information regarding this application, please contact Assistant Engineer Eric Hinkley.

30. Notes

    Backflow prevention assemblies must be installed per City Standards, tested by a tester listed on San Mateo County’s Environmental Health’s list of Certified Backflow Prevention testers, and tagged with a County tag. For more information, please contact <a href="mailto:kelgin@smcgov.org">Kate Elgin</a> at 650-399-6919. <br><br> Prior to initiating water service, the owner must test all backflow prevention assemblies and submit passing test results to <a href=mailto:water@menlopark.org target="_self" class="Hyperlink">Menlo Park Municipal Water</a> or visit the <a href=http://www.smchealth.org/crossconnection target="_self" class="Hyperlink">San Mateo County Cross Connection Control Program</a>.

    Backflow prevention assemblies must be installed per City Standards, tested by a tester listed on San Mateo County’s Environmental Health’s list of Certified Backflow Prevention testers, and tagged with a County tag. For more information, please contact Kate Elgin at 650-399-6919.
    
    Prior to initiating water service, the owner must test all backflow prevention assemblies and submit passing test results to Menlo Park Municipal Water or visit the San Mateo County Cross Connection Control Program.

34. Existing meter to be removed?

    1. No

    1. Yes
35. Existing service line to be replaced?

    1. No

    1. Yes
37. Existing Meters

    1. Domestic
    2. Irrigation
    3. Fire
38. Qty - Size - Meter #

40. New Meters

    1. Domestic
    2. Irrigation
    3. Fire

41. Qty - Size

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field