2011-00677 - pass through fees - Laserfiche WebLink

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S 3 ',(t.-;,MJ;' 4v OVA:.. v t" .',4:41,''''007,-$ .' '. .' Coo L -7D SAC Charge(2011 Rate=$2,230.00) X 9 un I tS $ / (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) not prepaid,a sewer connection permit will not be issued) I j 00 Sewer Connection Charge—City of Wayzata(Pass Through Fee) $ i L'-7 ' ' (2011 Rate=$575.00) X Oq lN“ t S 3. -0 0C Water Connection Charge—City of Wayzata(Pass Through Fee) $ COO i (2011 Rate-$2,080.00) X 0.-q L L v-\ I- S ❑ Water Connection Opt-Out—(Please Initial) I am choosing not to hook-up to water at this time. ❑ Water Availability— (Please Initial) I am choosing not to hook-up to water at this time. I have chosen to have my contractor make it water available for future hook-up. Water Availability Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Depai intent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit TOTAL PERMIT FEE(Add Fees Listed Above) $ i ADDITIONAL INFORMATION—WATER METERS • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. Typically the contractor will pick-up and pay for this permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of meter installation. The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota,and certifies that all statements made on this application are,true and correct. Owner: Date: