appendix 1 residential connection form and permit application

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Demand to Equivalent Dwelling Units (EDUs) Irrigated Landscape Category Water Use (AFY) EDUs Landscape (non-turf) Ornamental Turf Special Landscape Area (recreational turf) 1. In completing the Residentail Irrigation Connection Form and Permit Application, the undersigned acknowledges that any discrepancy or mistake may cause rejection or delay in processing the application. Additionally, the undersigned is responsible for accurately accounting for all water fixtures and irrigation areas. If the fixture unit count, irrigation areas, or or business type changes without notification to the District, or if a difference in fixtures, irrigatio areas, or business type is documented upon official inspection, water permits for the property may be cancelled. In addition, if water fixtures or irriagtion systems are installed or a change of business type occurs without a water permit, then this may be cause for interruptions of the water service to the site, additional fees and penalties, the imposition of a lien on the property, and deduction from the local jurisdiction's allocation. 2.In completing the Residentail Irrigation Connection Form and Permit Application, the undersigned acknowledges that MCWD Code 6.08.040, Paragraph D states “If connection is not made to the District’s water or recycled water system within one year from the date a capacity charge is paid after the effective date of this provision (August 8, 2007), the difference between the amount of the capacity charge paid and the amount of the revised capacity charge in effect at the time of the connection shall be paid to the District before the connection is installed”. 3. Upon installation of the water meter, the undersigned acknowledges that a Back Flow Preventer Assembly (BFP) Test shall be conducted by a Certified BFP Assembly Tester within two weeks of meter installation. Failure to do so within the time frame and/or failed test results may result in removal or lockout of the meter. I certify, under the penalty of perjury, that the information provided on the Residentail Irrigation Connection Form and Permit Application is to my knowledge correct, and the information accurately reflects the changes affecting water presently planned for this property. Signature of Owner/Agent Date This form expires on the same date as any discretionary or building permits issued for this project by the city or county expire. For MCWD only: Date Received: Meter Installation Approval Date: By: By: District Engineer Exterior Water Equivalent Dwelling Units (EDU): Proposed Total Water Demand: Existing Water Demand: Net Increase in Demand: Exterior Water EDUs: Previous EDUs Paid: Net EDU's Due: AFY AFY AFY EDUs @ 0.33 AFY/EDU EDUs Irrigtion Water Meter Size: Fees and Capacity Charges Calculations Svc Area: Fees Fee Schedule No. Units Extension Preliminary Project Review Fee, New Construction $ 500.00 $ Preliminary Review Fee, Comm. Modifications $ 400.00 $ Additional Review Fees (actual cost) $ $ Irrigation Meter Installation Fee: $ $ Exterior Water Capacity Charge (see EDU calcs): $ $ Construction Inspection (single lot): $ 400.00 $ Construction Inspection (large project): $ 500.00 $ Total $ * * Fee estimate not final until reviewed by MCWD staff. June 2009 2 of 3
Backflow Devices: Irrigation: Size: Quantity: Size: Quantity: Additional Review Fees: Reviewer: Hours: Rate: Subtotal: District Engineer $ 105.00 $ - Capital Projects Manager $ 85.00 $ - Project Engineer $ 68.00 $ - Associate Engineer $ 63.00 $ - Consultant $ - Total $ - June 2009 3 of 3
Page 1 and 2: APPENDIX 1 RESIDENTIAL CONNECTION F
Page 3 and 4: No. Fixture Units per Total Fixture
Page 5: MARINA COAST WATER DISTRICT 11 Rese
Page 9 and 10: MARINA COAST WATER DISTRICT 11 Rese
Page 11 and 12: TABLE NO. 2 - POST-PROJECT PROPERTY
Page 13 and 14: Fees and Capacity Charges Calculati
Page 15 and 16: EXAMPLE CONSTRUCTION AND TRANSFER O
Page 17 and 18: EXAMPLE CONSTRUCTION AND TRANSFER O
Page 19 and 20: EXAMPLE this Agreement, and the In-
Page 21 and 22: EXAMPLE services in the amount of $
Page 23 and 24: EXAMPLE 11.1.2 A complete, detailed
Page 25 and 26: EXAMPLE 16. No Water, Recycled Wate
Page 27 and 28: EXAMPLE NOTICE: IN AGREEING TO THE
Page 29 and 30: EXAMPLE 28. Exhibits 28.1 All exhib
Page 31 and 32: EXAMPLE EXHIBIT A CITY RESOLUTION M
Page 33 and 34: EXAMPLE EXHIBIT C MAP OF DEVELOPMEN
Page 35 and 36: EXAMPLE of concern (“MEC”). All
Page 37 and 38: EXAMPLE Deductibles and Self-Insure
Page 39 and 40: EXAMPLE EXHIBIT E NOTICE TO BUYERS
Page 41 and 42: Date Development Company, LLC Attn:
Page 43 and 44: APPENDIX 5 CHECKLIST FOR PLAN CHECK
Page 45 and 46: PART A: ADMINISTRATIVE REQUIREMENTS
Page 47 and 48: Footnotes 1. The MCWD Code Section
Page 49 and 50: No. Item App. B-10 If the plans are
Page 51 and 52: No. Item App. B-28 Is there a City
Page 53 and 54: PART C: REQUIREMENTS FOR DOMESTIC (
Page 55 and 56: No. Item App. Rev. Init. Reviewer C
Page 57 and 58:
PART D: REQUIREMENTS FOR RECYCLED W
Page 59 and 60:
No. Item App. D-15 Water service la
Page 61 and 62:
No. Item App. b) Correct material (
Page 63 and 64:
PART F: REQUIREMENTS FOR SUBDIVISIO
Page 65 and 66:
No. Item App. G-03 Has an Irrigatio
Page 67 and 68:
PART H: WATER CONSERVING APPLIANCES
Page 69 and 70:
PART I: REQUIREMENTS FOR HOT WATER
Page 71 and 72:
APPENDIX 6 BOND WORKSHEET
Page 73 and 74:
DOMESTIC WATER, SEWER, RECYCLED WAT
Page 75 and 76:
APPENDIX 7 DEVELOPER’S REQUIRED I
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APPENDIX 8 CONSTRUCTION PERMIT APPL
Page 79 and 80:
APPENDIX 9 COST OF CONSTRUCTION STA
Page 81 and 82:
Marina Coast Water 11 Reservation R
Page 83 and 84:
APPENDIX 10 BILLS OF SALE (DOMESTIC
Page 85 and 86:
IN WITNESS WHEREOF, the other parti
Page 87 and 88:
Marina Coast Water 11 Reservation R
Page 89 and 90:
EXHIBIT A - PROPERTY DESCRIPTION Ap
Page 91 and 92:
IN WITNESS WHEREOF, the other parti
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appendix 1 residential connection form and permit application

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