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FOR CITY USE ONLY i-1 <br /> /*0 City of Orono Date Received: 7 /C//j/Permit#Orb!I^'l - V <br /> P.O.Box 66 <br /> . jh 2750 Kelley Parkway 0 In-House SAC Determination Form Completed <br /> 442°St r Crystal Bay,MN 55323 12'4- C OIatr`C f 1 (JAW-- LP/2..3/f f <br /> .1114' �bs' (952)249-4600 Approved By(If Required): <br /> CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM <br /> WAYZATA-SEWER&WATER PASS THROUGH CONNECTION FEES& SAC FEES <br /> (ALL PERMITS-May be subject to further review and may not be issued when the application is received) <br /> PERMIT CODES(IN-HOUSE) <br /> Sewer/Residential/Pass Through Fees/Blank <br /> Water/Residential/Pass Through Fees/Blank <br /> Sewer&Water/Residential/Pass Through Fees/Blank <br /> GENERAL INFORMATION <br /> I. SAC&SEWER&WATER CONNECTION FEES CAN'T BE PREPAID—UNLESS THE <br /> CONTRACTOR WILL BE PULLING THE PERMIT IN A FEW DAYS. <br /> (PER MET COUNCIL). <br /> 2. If payments are made: Prior to the actual sewer or water connection permit(pulled by the <br /> contractor)the payment will be held until that permit is received and paid for. <br /> 3. These payments can only be made with check or cash,because they are pass through fees. <br /> 4. If you the homeowner wants proof of this payment,we will hand write a payment receipt. <br /> 5. We will not hold this payment more than a few days to one week,at which time if the contractor <br /> does not come in we could reserve the right to return your check to you,or collect additional fees <br /> that could change. <br /> 6. Once the sewer or water connection permit is issued,we will issue this permit and send you the <br /> homeowner a copy. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> [Residential(May Require Approval) <br /> [New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: g-15 \) �s- 4 Q ? l vcA <br /> Owner:_c--1) Mailing Address: <br /> City: NAP`S Zip: .._"5S ? 1 <br /> Home Phone: Alternate Phone: <br />