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City of Modesto House Sewer Line Repair Cost-Share Program Application to Participate I/We are reques ng to par cipate in the City of Modesto House Sewer Line Repair Cost-Share Program (CSP) for repair of the house sewer line in the public right-of-way. I/We are the legal owners of the following de- scribed property, which requires a repair of the house sewer line located in the public right-of-way: Site Address: Owner/Applicant’s Name: Mailing Address: Telephone: (Home) (Work) I/We are reques ng the following op on for cost sharing offered through the program: Reimbursement op on Loan op on (not available for a “Clean-out Only”) AS APPLICANT(S), I/WE AGREE TO THE FOLLOWING TERMS: I/We understand and agree that this applica on may be refused it is determined that any of the following situa- ons exist: 1. The property is not a residen al property 2. The repair or replacement work is not in the public right-of-way, or 3. The work is not completed by a Class A General Contractor or a C-34 Pipeline Contractor, or 4. All necessary paperwork is not submi9ed to the CSP Coordinator and approved prior to the start of any work. I/We agree that the City of Modesto will provide financial assistance through reimbursement and/or a loan for the cost of the repair to the house sewer line located in the public right-of-way. If the loan op on is selected, I/ We agree to pay the required fees for establishment of a loan. I/We agree that any remaining costs for the repair in the public right-of-way is at my/our expense. I/We agree that the total cost for any repair of the house sewer line located on private property is at my/our expense. I/We understand that the Sec on 5-6.309 of the Modesto Municipal Code states: “Each user shall be responsible for the construcon, maintenance and repair of his or her house sewer line. Each user shall be liable for damages which may result to the sewage system from his or her failure to keep his or her house sewer line in good order.” I/We agree to the above condi ons: APPLICANT: (Signature) (Signature)