Form Ww 172 PDF Details

Embarking on the installation of a new metered water service connection within a Los Angeles County Waterworks District necessitates a comprehensive understanding and completion of the WW 172 form. This crucial form acts as an informational sheet and application, guiding property owners through the protocols to secure a reliable water service to their property. It encompasses not only critical identification details such as the property owner’s name and address but also intricate aspects like the land use, zoning, and the legal description of the property. The form further delves into the expected water usage, pinpointing the maximum domestic demand, the number of fixture units, and specific service connection sizes required. Applicants are prompted to provide a schematic drawing or description of the water use area, revealing the preferred location for the meter and related structures. It also probes into the property’s past connections to district water and current or prospective elements such as sewage and storm drain pumps, wells, and even tanks containing toxic substances. Clear distinctions are made concerning the property’s service class, encompassing residential, business, industrial, and agricultural uses. Additionally, it covers cross-connection information and fire flow requirements, emphasizing the need for backflow prevention and the specifications demanded by the Fire Department. By obligating property owners to agree to the terms and accept responsibility for water service bills, the form underscores the importance of adherence to regulations and the district's authority over installed water service infrastructure. The WW 172 form is not just an application but a binding agreement, ensuring the proper use and billing of water services, tailored to meet the diverse needs of Los Angeles County residents.

QuestionAnswer
Form NameForm Ww 172
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmywam, la county waterworks, easements, GPM

Form Preview Example

INFORMATION SHEET AND APPLICATION FOR NEW METERED WATER SERVICE CONNECTION IN A LOS ANGELES COUNTY WATERWORKS DISTRICT

MAIN OFFICE

LANCASTER OFFICE

MALIBU CIVIC CENTER OFFICE

P. O. Box 1460

260 E. Avenue K-8

23533 W. Civic Center Way

Alhambra, CA 91802-1460

Lancaster, CA 93534

Malibu, CA 90265

(626) 300-3335

(661) 942-1157

(310) 456-6621

7:00 AM - 5:30 PM

8:00 AM - 5:00 PM

8:00 AM - 4:30 PM

Monday - Thursday

Monday - Friday

Monday - Friday

A. GENERAL INFORMATION: Property Owner must complete this form and sign on back page at bottom. Type or print clearly in ink. If you need additional space, use plain paper and attach to this form.

Name of Property Owner:

Address of Property Owner:

City:

 

State:

Zip Code:

 

 

 

 

Telephone No: (

)

-

 

*Name of Person Who Will Receive Water Bill:

Address Water Bill Is To Be Sent To:

City:

 

State:

Zip Code:

 

 

 

 

Telephone No: (

)

-

 

Address of Property To Be Served:

Legal Description of Property: (If you have information already on a typed page, attach to this form.)

Land Use

Assessor Map Book

 

 

 

Page No.

 

 

 

Parcel No.

 

 

 

 

Zoning

Tract No.

 

 

Lot No.

 

 

Parcel Map No.

 

Parcel No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* If Water Bill is to be mailed to other than the owner and if owner wants a notice when bill is delinquent, Please check box: YES

 

NO

 

 

 

 

 

 

 

 

 

Maximum domestic demand (include sprinkling and irrigation) ________ GPM (gallons per minute).

 

 

 

Total number of fixture units (per chart of Form WW 174) _________.

 

 

 

 

 

 

Height of highest point of water use above meter elevation ________ feet.

 

 

 

 

 

 

Distance from meter to farthest fixture _______ feet.

 

 

 

 

 

 

Size of meter requested ________ inches.

 

Size of service connection requested ________ inches.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. WATER SERVICE INFORMATION: Sketch or describe water use area in space below (with respect to total ownership). Show the desired location of meter, the property lines, driveways and the proposed structures.

Has this property ever been served with District water? YES NO .

If answer is yes, describe or show. Insert driveways and access easements. If you have a plot or development plan, please attach.

Memo Billing:

Received By:

Reviewed By:

Inquiry No.

Service Letter

OFFICE

 

 

 

YES

 

NO

 

 

 

 

USE

 

 

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

Date:

Date:

Date:

Date:

Date:

 

 

WW172 - FRONT 10/2005

Are there any existing or proposed: 1 sewage pumps?
2 process pumps?
3 storm drain (or sump) pumps?
4 booster pumps?
5 wells?
6 well pumps?
7 tanks containing toxic substances?
8 mobile homes or trailers?

C. CLASS OF SERVICE:CHECK THE BOX THAT BEST DESCRIBES THE USE OF THIS PROPERTY

Residential, Single (1 Unit)

Residential, Duplex (2 Units) *

Residential, Multiple (3 Units or More) *

Business (Commercial) * Industrial (Manufacturing) * Irrigation (Agricultural)

For Resale to

Temporary, for Construction of Use Outside of District Public Agency for

Private Fire Protection (Backflow Detector Assembly) Combined Private Fire and Domestic Flow (FM-CT Meter)

*Give House Number of Each Unit, Store or Building on Front Page

D. CROSS-CONNECTION INFORMATION: CHECK EITHER BOX FOR EACH QUESTION THAT PERTAINS TO YOUR PREMISES USE

YES NO

Are there any existing or proposed:

YES

 

NO

9

tanks containing non-toxic substances?

 

 

 

10

water tanks (exclusive of hot water heater)?

 

 

 

 

 

 

11

industrial processes using water

 

 

 

 

(for cooling, mixing or flushing)?

 

 

 

 

 

 

12

aspirating devices using water?

 

 

 

 

 

 

 

 

 

 

 

 

13

fire sprinkler systems on the premises?

 

 

 

 

 

 

 

 

 

 

14

fertilizers injected under water pressure?

 

 

 

 

 

 

15

on-premise backflow prevention devices?

 

 

 

 

 

 

 

 

E. FIRE FLOW REQUIREMENTS:

 

Do any fire protection requirements (set by Fire Department) exist for this property or by law can the

Fire Department set requirements? YES

 

 

NO

 

. If yes, answer following questions.

 

 

ENCLOSE A COPY OF ANY

 

 

 

 

REQUIREMENTS OF FIRE DEPARTMENT WHEN YOU RETURN INFORMATION SHEET

Size of fire meter requested

 

 

 

inches.

 

 

Diameter of fire service connection requested

inches.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Public fire hydrant flow of

 

GPM (at 20 psi) from hydrant (s) located at:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Private on-site hydrant flow of

 

 

 

GPM (at 20 psi) from hydrant (s) located at:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Private on-site fire protection sprinkler system flow of

 

 

GPM at

psi for fire sprinklers located at:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please check either box, if applicable: (1) for private on-site fire hydrant or fire sprinkler system, a separate backflow detector assembly is needed

or (2) a combined fire protection and domestic meter service is needed

.

 

 

 

 

F.Upon the return of this Information Sheet, completely filled out and signed by the property owner, the District will notify you of the charges and on any special conditions for water service on the Application Sheet.

GENERAL CONDITIONS

The property owner hereby applies for water service as stated and hereby agrees to accept and pay for said service at the rates and the conditions of the Rules and Regulations of the Los Angeles County Waterworks Districts. The property owner remains, at all times, responsible for the water bill regardless of the owner designating that the water bills are to be addressed to a tenant or some other person.

The property owner agrees to limit his development and use of water to only that portion for which Capital Improvement and Local System Improvement Charges have been paid; and he further agrees to pay the applicable charges at such time as he extends his water use area.

All meters, pipes, valves, fittings and other facilities, installed pursuant to this application, shall be and remain the property of the Waterworks District.

Service may be discontinued without notice to a property which is delinquent in payment of water bill and meter service will not be maintained or resumed until the full amount of all then due charges has been paid.

This application is for temporary service and the period of use can not exceed six months. Permanent service can only be obtained upon satisfaction of all requirements of District.

Signature of Property Owner (Required)

Date

OFFICE USE ONLY

WW172 - BACK 10/2005

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Filling out this PDF demands attentiveness. Make sure all mandatory fields are filled out properly.

1. The easements involves certain details to be entered. Ensure that the next fields are finalized:

la county waterworks writing process outlined (portion 1)

2. Once the previous section is finished, it is time to add the required particulars in If Water Bill is to be mailed to, Memo Billing, Received By, Reviewed By, Inquiry No, Service Letter, and OFFICE USE ONLY so that you can move on further.

How to fill out la county waterworks part 2

As to If Water Bill is to be mailed to and Received By, ensure you double-check them in this current part. The two of these are the key ones in the file.

3. This next step is related to OFFICE USE ONLY, Date, WW FRONT, Date, Date, Date, Date, and YES NO - fill in each one of these empty form fields.

la county waterworks completion process shown (stage 3)

4. Filling in C CLASS OF SERVICE, CHECK THE BOX THAT BEST DESCRIBES, Residential Single Unit, For Resale to Temporary for, Give House Number of Each Unit, D CROSSCONNECTION INFORMATION, Are there any existing or proposed, YES, Are there any existing or proposed, YES, sewage pumps process pumps, wells, tanks containing nontoxic, industrial processes using water, and fire sprinkler systems on the is crucial in this section - you'll want to don't hurry and fill in every single empty field!

Filling out segment 4 in la county waterworks

5. This form must be wrapped up by dealing with this part. Further there can be found a detailed set of blanks that require correct information in order for your document usage to be accomplished: ENCLOSE A COPY OF ANY REQUIREMENTS, Size of fire meter requested inches, Diameter of fire service, Public fire hydrant flow of GPM at, Private onsite hydrant flow of GPM, Private onsite fire protection, Please check either box if, F Upon the return of this, GENERAL CONDITIONS, The property owner hereby applies, The property owner agrees to limit, All meters pipes valves fittings, Service may be discontinued, and This application is for temporary.

Step no. 5 of submitting la county waterworks

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