Water Connection Application

2. IMPORTANT NOTE: Before submitting a Water Connection Application, the applicant must read the Water Connection Guidelines.

   The applicant shall:

   • Complete and submit the Water Connection Application below.
   • Attach a copy of the stamped and approved Menlo Park Fire Protection District 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 601-370-34901

   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 (Fire District sprinkler plans, site utilities plans, irrigation plans, etc.)*
28. For more information regarding this application, please contact Menlo Park Municipal Water.
30. Notes

    Backflow prevention assemblies must be installed per City Standards, tested by a certified Backflow Prevention Tester on the San Mateo County Environmental Health Services' list of Certified Backflow Prevention Testers, and affixed with a County tag upon successful testing. For more information, please contact San Mateo County Environmental Health Services at 650-372-6200 or backflow@smcgov.org.

    
    

    Prior to initiating water service, the owner must test all backflow prevention assemblies and submit passing test results to Menlo Park Municipal Water.

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:


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

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field