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a � <br /> ���I��'�ST��1�,'�' ' , <br /> O���O City of Orono Aate�ece�e�t � P.�n�t# <br /> P.O.Box 66 � y . � �� � � <br /> � 2750 Kelley Parkway � {�IFi House S}�T�let�rmutafi0n��t`[n��`�om�leted> -' <br /> ��` , � Crystal Bay,MN 55323 ^ ; <br /> �9sz�2a9-a�oo ��p�v��y����rea� � '�� <br /> "ri� _ } .. �. : , .`. <br /> . �_. �., b.,. . . ... . �.z ,� . <br /> CITY OF ORONO-HOMEOWNER SUPPLEMENTAL FORM <br /> WAYZATA- SEWER&WATER PASS THROUGH CONNECTION FEES& SAC FEES <br /> (ALL PERMII'S-Mav be subiect to further review aad mav not be issued when t6e aoulication is receivedl <br /> PERMIT CODES(IN-HOUSE) <br /> Sewer/Residential/Pass Tlvough Fees/Blank <br /> Waur/Residential/Pass T6rough Fees/Blank <br /> Sewer&W ater/Residential/Pass Through Fees/Blank <br /> CENER:A�;�����Jl�t ., � :; <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 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 co�iy. <br /> � � <br /> � ' � �`.��(3���'��TT�' � � �, � <br /> � � <br /> �, �.� � � ,�� �+��c���.."1�ia�t�A; � �� � ' � <br /> ❑Residential(May Require Approval) <br /> ❑New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> f0�'�1"�L��-�tBT�f(�21T1�1t��1 �� <br /> e� '� <br /> Site Address: Z� ���J/ZtL� l�l�„�ip� �/� <br /> Owner: �� �� • ��v�G� Mailing Address: ��^ Gl��� <br /> c�r�: �/�/y-o z�p: �.�3� / <br /> Home Phone: �.S�Z- Y ��- Alternate Phone: ��Z - .��p �- Q�� Z <br /> ���� <br />