Laserfiche WebLink
o� <br /> n ���� • <br /> ' � n � `�/ <br /> . �"�� <br /> =� `'j FOR�ITY USE ONLY <br /> '��Q-�IV��, City of Orono Date Received: ���!,�Permit� �� �( �'rj�`Q <br /> , P.O.Box 66 ��� �S <br /> ! 2750 Kelley Parkway �In-House SAC Determination Form Completed <br /> `'•�*,� t �'/ Crystal Bay,MN 55323 <br /> \�R,�.F�µ�j� (952)249-4600 Approved By(If Required): ��. <br /> '���___.- � � <br /> CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM �O fj-� ( I� " <br /> WAYZATA- SEWER&WATER PASS THROUGH CONNECTION FEES & SAC FEES v <br /> (ALL PERMITS-Mav be subiect to further review and mav not be issued when the aaolication is receivedl �� I�I� <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 /> 1. SAC&SEWER&WATER CONNECTION FEES CAN'T BE PREPAID—LINLESS 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 A 1 <br /> �C Residential(May Require Approval) <br /> � New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: (�'7 �Mv��\��.� „;� (1� <br /> Owner:c�,,,,,r�- >� 1 .:r,� k��, Mailing Address: 115�)��'' c�-�.:,�.�:1c.:,� � l <br /> City: t � r�� �'r-U�-�� Zip: �S,3``<<-I <br /> Home Phone: `�S�- [��l`� ��7(��3 Alternate Phone: <br /> . <br /> �`�v``��' <br />