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� <br /> 1 � <br /> FOR CITY USE ONLY <br /> ' 0,��,�`O City of Orono Date Received: Permit# <br /> `r P.O.Box 66 <br /> �,"`� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed <br /> a� '1 ? p'' Crystal Bay,MN 55323 <br /> '� ��,a yG� (952)249-4600 Approved By(If Required): <br /> ��ao� <br /> CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM <br /> WAYZATA- SEWER&WATER PASS THROUGH CONNECTION FEES & SAC FEES <br /> (ALL PERMITS-Mav be subiect to further review and mav not be issued when the ao�lication 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 INFORMATION <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: Pnor to the actual sewer or water connecrion permit(pulled by the <br /> contractor)the payment will be held until 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 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 PERMTT <br /> (Check All That Apply) <br /> Residenrial(May Require Approval) <br /> New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/ Owner Information: <br /> Site Address: -r-i L ,,,., �_ �,� c v � �1�+ <br /> Owner: �� f 7�.c �� Mailing Address: � f"` <br /> City: �`�rZi�` � � Zip: �S3�1 � <br /> Home Phone: ��t��� ��3-' �S• -I Z Alternate Phone: (2 � 5 - � �:� <br /> �� � <br />