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FOR Cl `1't SE OMx <br /> (111-1-4446\ CityP.O.Box 66 of Orono Date Received: Permit# <br /> ( •� 2750 Kelley Parkway 0 in House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> V1&ES HQ . (952)249-4600 Approved By(If Required):.. <br /> CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM <br /> LONG LAKE-SEWER&WATER PASS THROUGH CONNECTION FEES <br /> & SAC FEES <br /> (ALL PERMITS-May be subiect to further review and may not be issued when the application 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: 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 Apply) <br /> ,Residential(May Require Approval) <br /> -New Connection ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: b Q V e-f 4' <br /> Owner: 0Mailing Address: <br /> s <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br />