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Private Sewer Lateral Program
Rebate Application
(Please rint)
Please read all of the information about this program on the back page, including rebate requirements
and the procedure. If you have questions regarding the City's Private Sewer Lateral Program, please call
Jeremy Gearhartat (805) 781-7033 or email atjgearhart@slocity.org.
1. General Information
City Permit Number f�)C-OSl6 -zeal Tron' Lateral Replacement Cost: S \ i f a act
enone Assessor's Parcel Number (APN)'
Address: 1'j 00 OSCS S'Cl Plparype(ardeon>i NDP ABS PVC
Contractor Name: CI.D 'ff C/�E.n1Uhl-IE$ 5 Phone: go�i r 1 . Z,G
Improvement i Rebate (check pre): l
� ❑ Full Private Sewer Lateral Replacement $2,000 Rebate
P Full Private Sewer Lateral Replacement in Capacity Constrained Area $3,000 Rebate•
❑ Full Private Sewer Lateral Replacement completed between 7/1/17 and 8/20119 $1.080 Rebate•
'Notes: Lateral replacement must include new connacann to C1ty main Reusing an exishhg connection or parlal lateral
replacement we rmt qualify brit a rebate. Rehate amount we nor exceed 50 percent of total lateral replacement cost ceples of
receipts must be branded with applti atpn to verily Mar replacement cost Capacity onretrained areas am shown on page 2.
Rebates twiRdvale lateral replacements Wrnpktedhe"an July 1, 2017snd August 20, 2019 am availabk until June 30, 202E
2. Property Owner Information and Signature
Fill out the name and address for whom you would like the rebate check made out and the address to be
mailed to (does not have to match the service address above
Name (to be shown on check):
City:
State:
I have mad, understand, a nditions as stated on this page and an page 2 of
this application.
Property Owner Signature: Date:
Return completed application to: City of San Luis Obispo Utilities Department
(attn. Sewer Lateral Rebate)
879 Morro Street
San Luis Obispo, CA 93401
Or email application to: jgsarhartigslpdty.org
OFFICIAL USE ONLY
Received via:o Rand-0a0ver o Mail ❑ Email Received by H.S. Date: 3/23/2021
Verification by: H.S. Dare: 3/23/2021
Application: o Approved [11�enied
Rebate Approved by HS Date: 3/23/2021 Rebels Amount $3,000
Comments.
iw
Mark Alonzo Construction LLC
PHONE: (805) 801-2616
EMAIL: alonzacnnsbuct@sbcglobal.net
A -GENERAL ENGINEERING LICENSE B I"
B�GENERAL CONTRACTOR LICENSE NO. 710777
Customer Name: -
Invaim It.
Invaim Date: 03-16-2021
Customer!'hona:-
Customer Address:
1 700 OSOS STREET - TRENCHLESS SEWER LATERAL
PIPESURSTING TECHNOLOGY.
- INSTALLED APPROX. 65 FT. OF 4" SDR-17 HDPE. ALL JOINTS HEAT
WELDED (BUTT FUSION AND ELECTROFUSION TECHNOLOGY)
TIE INTO MAIN SEWER LINE WITH NEW WYE CONNECTION.
-TIE IN EXISTING HOUSE LINES.
-TRAFFIC CONTROL PROVIDED PER APPROVED PLAN
- CONCRETE SLURRY AND ASPHALT PAVING AS WELL AS ALL
CONNECTIONS AND EXCAVATIONS AS PER CRY STANDARD
SPECIFICATIONS & ENGINEERING STANDARDS.
- FINAL VIDEO SUBMTRHD TO CrrY PUBLIC WORKS FOR REVIEW.
MAKE CHECK(S) PAYABLE TO:
SLO TRENCHLESS
P.O. BOX 1301 1
SAN Luis OBISPO, CA 93406
'WA?
\�I
OVER 25 YEARS EXPERIENCE
DEPOSIT AMOUNT
CONTRACT PRICE $1 1 ,989.00
BALANCE DUE $9,989.00
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