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Application to Transfer Private Infrastructure to Ogden City Ownership Please print legibly and complete all areas: Ogden City Development Services 2549 Washington Blvd. Suite 240 Ogden, Utah 84401 (801) 629-8930 Applicant Contact Information (current owner of infrastructure) Name: Address: City: State: Zip: Phone: E-mail (please print): The following checklist can be used as a guide □ Application must be submitted to the City Engineer. □ A description of the private infrastructure to be transferred to City ownership; □ Signatures of all persons having any ownership interest in the private infrastructure requested to be transferred; (If owned by a homeowner’s association, petition may be signed by all lot/unit owners or any authorized officer, pursuant to a resolution of the HOA.) □ Pay a nonrefundable fee, in the amount of one hundred dollars ($100) □ A report prepared by a qualified and disinterested expert investigating and providing such technical information as determined by the City Engineer to be necessary to adequately describe the condition of the private infrastructure requested to be transferred. The expert’s qualifications and the scope of the report shall be approved by the City Engineer. In lieu of the report, the owners may provide a cash deposit for the costs as determined by the City Engineer. Any portion of the deposit that is unused during the technical investigation will be returned to the owners. Description of private infrastructure to be transferred: (Petition signatures on reverse) ---PAGE BREAK--- Owner’s Signature Print Name Address Date