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FOR CITY USE ONLY <br /> O,���O City of OrOno Date Received: permit# <br /> P.O.Box 66 <br /> 2750 Kelley Parkway ❑In-House SAC Determination:Form Completed <br /> � . `�! ;. � Crystal Bay,MN 55323 <br /> � (952)249-4600 Approved By(If Required): <br /> ��08�' <br /> CITY OF ORONO-HOMEOWNER SUPPLEMENTAL FORM <br /> WAYZATA- SEWER& WATER PASS THItOUGA CONNECTION FEES & SAC FEES <br /> (ALL PERMITS-Mav be subiect to further review and mav not be issued when the aoolication 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 INFORIVIATION <br /> 1. 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 unril that pernut 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 rime 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 pernut 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 /> ❑Residential(May Require Approval) <br /> ❑ New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> 7ob Site/Owner Information: <br /> Site Address: � S Y'�y r �I e wcX� �o(. <br /> p c <br /> Owner: f�p�i vv��(.vt��-�.e Mailing Address: � S ✓�y��" I'e�''�bc���• <br /> City: w�ZG�� Zip; S S^3 cl � <br /> Home Phone: �0 IZ �'�� � �8� Alternate Phone: <br />