Laserfiche WebLink
- City Use Only - <br />CITY OF LA PORTE PLANNING DEPARTMENT <br />Rec’d by: _________________ Date: ___________________ <br />604 West Fairmont Parkway, La Porte, TX 77571 <br />Phone: 281.471.5020, Fax: 281.470.5005 <br />Date of Initial Review Meeting:________________________ <br />www.laportetx.gov <br />Date of Internal Review Meeting: ______________________ <br />Request Meets Policy Guidelines?: Y or N <br />APPLICATION for WATER / SEWER SERVICE to COMPANIES <br />Date of Notification to Company: ______________________ <br />WITH AN INDUSTRIAL DISTRICT AGREEMENT (IDA) <br />Note: Submittal of partial or incomplete information may delay processing of your application <br />1.) COMPANY NAME (per Applicant’s IDA w/ City): 2.) *SITE TENANT (if other than “Company”): <br />Dmbsl!Ejfusjdi!Cvjmejoh!Tztufnt <br />Opsui!Cbzqpsu!Joevtusjbm!Qbsl!JJ-!Mue/ <br />Name:_______________________________________________ Company Name:___________________________________________ <br />421.437.5858624.981.2211 <br />Phone #:________________________________________ _____ Phone #__________________________________________________ <br />624.981.2411 <br />421.437.6224 <br />Fax #:_______________________________________________ Fax #:____________________________________________________ <br />:161!Dfousf!Qpjouf!Esjwf-!Tvjuf!511- <br />esdAuvggmj/dpn <br />E-Mail: _________________________________________ _____ Address:__________________________________________________ <br />Xftu!Diftufs-!PI!5617: <br />3356!Xftu!2:1ui!Tusffu- <br />Company Address:_____________________________________ _________________________________________________________ <br />Upssbodf-!DB!:1615 <br />Csboepo!Cjtups <br />_____________________________________________________ Contact Name: _____________________________________________ <br />3.) PROPERTY DATA (If available, include any survey, plat, site plan, map or sketch of the subject site with this form): <br />58 <br />*Company’s Industrial District Agreement No.: 2007 – IDA - ______________ <br />:811!Ofx!Efdbef!Esjwf-!Qbtbefob-!UY!88618 <br />*Site Address:_____________________________________________________________________________________________________ <br />2!!!3!!!1!!!!8!!!3!!!9!!!!1!!!1!!!1!!!!1!!!1!!!3!!!8 <br />Site HCAD ID(s): ___ ___ ___ - ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ ; ___ ___ ___ - ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ ; <br /> ___ ___ ___ - ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ ; ___ ___ ___ - ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ <br />26/5154 <br />Total Site Acreage (Per Exhibit “A” of Company’s IDA): _____________ Acres <br />4.) SITE FACILITY INFORMATION (If available, include any site plan or sketch of the subject facility with this form): <br />New Construction <br />Qspqptfe!:5-:61!tr!gu!joevtusjbm!cvjmejoh!xjui!bttpdjbufe!qbwjoh- <br /> Describe Project: __________________________________________________________________________________________________ <br />esbjobhf!boe!vujmjujft <br /> ________________________________________________________________________________________________________________ <br />New Tenant Requesting Additional Water and/or Sanitary Sewer Allocation <br /> (Specify reason(s) for additional allocation request: _______________________________________________________________________ <br /> ________________________________________________________________________________________________________________ <br />56 <br /> *Full-time Regular + Full-time Contract Employees who will occupy this facility: ___________________ Total Full-Time Employees <br /> **Current Amount of Water Allocated to Company by existing Water Service Agreement: __________________________ gallons per month <br /> **Current Amount of Sewer Allocated to Company by existing Sewer Service Agreement: __________________________ gallons per month <br />5.) WATER SERVICE IS REQUESTED to COMPANY’S SITE FOR THE FOLLOWING PURPOSE(S): <br /> Domestic Uses (i.e. Drinking, Flushing, Etc.) <br />Gjsf!tvqqsfttjpo!tztufn-!op!joevtusjbm!xbufs!vtf <br />Other (describe): __________________________________________________________________________________ <br /> ________________________________________________________________________________________________ <br />6.)SANITARYSEWER SERVICE IS REQUESTED to COMPANY’S SITE FOR THE FOLLOWING PURPOSE(S): <br /> Domestic Uses (i.e. Wastewater from domestic uses) <br />Other (describe): ___________________________________________________________________________________ <br /> _________________________________________________________________________________________________ <br />* An Administrative Fee of $100 per employee is assessed for each agreement (Min Fee = $5,000; Max Fee = $15,000) <br />**If Applicable <br /> <br />