HomeMy WebLinkAbout2011-01519 - sewer pass through fees • ' CITY OF ORONO PERMIT NO.: 2011-01519
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 12/06/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 15 MYRTLEWOOD RD
PIN : 36-118-23-33-0013
LEGAL DESC : MYRTLEWOOD
: LOT 001 BLOCK 002
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : PASS THROUGH FEES
NOTE: THIS IS THE SEWER&SAC CONNECTION FEE FOR PERMIT#2011-
PAID VIA:OWNERS CHECK#4545 LISA ADAMS
APPLICANT
S.A.C. 2,230.00
JAMESWEATHER,ROBI SEWER CONNECTION CHARGE-WAYZATA 575.00
15 MYRTLEWOOD RD TOTAL 2,805.00
WAYZATA,MN 55391-
OWNER
JAMESWEATHER,ROBI
15 MYRTLEWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
pertnits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuriqg 'red inspections are
requested in confp e wi�ttie$ ing Code.This permit may be
revoked at arty time fo du e. j
�/ � / Q�� / /
A ' t.P itee Signature Date Issued By i ature Date
� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
FOR CITY USE ONLY
O,���O City of OrOno Date Received: permit#
P.O.Box 66
2750 Kelley Parkway ❑In-House SAC Determination:Form Completed
� . `�! ;. � Crystal Bay,MN 55323
� (952)249-4600 Approved By(If Required):
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CITY OF ORONO-HOMEOWNER SUPPLEMENTAL FORM
WAYZATA- SEWER& WATER PASS THItOUGA CONNECTION FEES & SAC FEES
(ALL PERMITS-Mav be subiect to further review and mav not be issued when the aoolication is received)
PERMIT CODES(IN-HOUSE)
Sewer/Residential/Pass Through Fees/Blank
Water/Residential/Pass Through Fees/Blank
Sewer&Water/Residential/Pass Through Fees/Blank
'GENERAL INFORIVIATION
1. SAC&SEWER&WATER CONNECTION FEES CAN'T BE PREPAID—UNLESS THE .
CONTRACTOR WILL BE PULLING THE PERMIT IN A FEW DAYS.
(PER MET COUNCIL).
2. If payments are made: Prior to the actual sewer or water connection permit(pulled by the
contractor)the payment will be held unril that pernut is received and paid for.
3. These payments can only be made with check or cash,because they are pass through fees.
4. If you the homeowner wants proof of this payment,we will hand write a payment receipt.
5. We will not hold this payment more than a few days to one week,at which rime if the contractor
does not come in we could reserve the right to return your check to you,or collect additional fees
that could change.
6. Once the sewer or water connection pernut is issued, we will issue this permit and send you the
homeowner a copy.
TYPE OF PERMIT
(Check All That A 1 )
❑Residential(May Require Approval)
❑ New Connection ❑ Water Availability Connection For Future Hook-Up to Water
7ob Site/Owner Information:
Site Address: � S Y'�y r �I e wcX� �o(.
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Owner: f�p�i vv��(.vt��-�.e Mailing Address: � S ✓�y��" I'e�''�bc���•
City: w�ZG�� Zip; S S^3 cl �
Home Phone: �0 IZ �'�� � �8� Alternate Phone:
�SAC Charge(2011 Rate=$2,230.00) $ 0�4�3� •� �
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
[�Sewer Connection Charge—City of Wayzata(Pass Through Fee) $ �75• V 0
(2011 Rate=$575.00)
❑Water Connection Charge—City of Wayzata(Pass Through Fee) $
(2011 Rate-$2,080.00)
❑ Water Connection Opt-Out—(Please Initial)
I am choosing not to hook-up to water at this time.
❑ Water Availability— (Please Initial)
I am choosing not to hook-up to water at this time. I have chosen to
have my contractor make it water available for future hook-up.
Water Availabilitv Explanation:
Contractor instailed line to inside of house for future hook-up.
This line will be inspected by the Public Works Deparhnent.
Required Before Water Connection Pernut is Issued:
1. Issue Water Meter&Hom Permit
2. Any Additional Connection Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee&Issue Water Connection Pernut
� G
TOTAL PERMIT FEE(Add Fees Listed Above) $ O�8�!• � �
ADDITIONAL IIVFORMATION—'WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a sevarate pernut.
Typically the contractor will pick-up and pay for this permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are,true and correct.
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Owner: �I JC�yVIQSWP1h-�'Yl��(� Date: ' C , � �1 S