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i <br /> � <br /> I <br /> � Metropolitan Council <br /> � Environmen�al Services ! <br /> SAC PAYMENT FORM <br /> The Metropolitan Council Environmental Services has determined that <br /> Company Name: Citv of Orono <br /> Facility Address: 2345 Blaine Avenue ' <br /> Community: Orono Permit Number: 1006 ' <br /> � <br /> i <br /> is required to obtain 3 Service Availability Charge {SAC) units at the 201d rate of$2,100 per unit � <br /> for an increase in the volume of wastewater discharged to the Metropolitan Disposal System. Payment of � <br /> applicable SAC is a Pernlit Condition described in Section 205.00 of the "Waste Discharge Rules for the ' <br /> Metropolitan Disposal System " All payments shall be made with this form to the Community in i <br /> which the above faciIity is located. � <br /> � <br /> Total amount due: $6,300 by 1/31/10 <br /> i � <br /> ! (or $6,000 if paid by 12/31/09} � <br /> � <br /> � Note: Payment of SAC does uot relieve companies of charges assessed by communities for an i <br /> increase in the volume of wastewater discharged through the local sanitary sewer. <br /> � <br /> i �*�****��x*��x*�x��*****�x****�x*�*�******�*�***�*�**�x******�*****�*�*****�****�*****�x�***x� j <br /> i <br /> i <br /> VERIFICATION OF PAYMENT <br /> To be completed by Community official I <br /> b � <br /> I verify that - , � y ���� ��/'z%'i�� �;� <br /> (Company name) � <br /> has paid _� SAC units on � 1--',3[ p I <br /> �/ � i <br /> � <br /> (date) j <br /> r � <br /> Signed: f���,�t�< � ��,-�'--� �! J' <br /> �� � � �� C.'-/t'�'�, <br /> � � <br /> (name) (title) <br /> representing. ���•�-�cf �'j ��� L��r'G�f� G j <br /> � (Community name} � <br /> ��/'�.' C': G��:i�f- �",�-�'�;�-f �i;`, �/ �c' --`�• o, -+�-f/��:"c'<' GS f=,�i��_T L�'� %Q�✓�1���,�i-�', i <br /> � " `` � <br /> Distribution: City of Orono should retain the original and send a copy to the Metropolitan Council '� <br /> Environmental Services, Industrial Waste & Pollution Prevention, 390 N Robert St, St Paul, MN 55101- i <br /> 1805. Thank you. ; <br /> . , � � ` <br />