HomeMy WebLinkAbout2010-00529 - sewer/water pass through fees " CITY OF ORONO PERMIT NO.: 2010-00529
2750 KELLEY PARKWAY
"' ORONO, MN 55356- DATE ISSUEn: 06/28/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 25 MYRTLEWOOD RD
PIN : 36-118-23-33-0014
LEGAL DESC : MYRTLEWOOD
: LOT 002 BLOCK 002
PERMIT TYPE . SEWER&WATER ._;,�� !;r;;t:y �tr�Ha.}
PROPERTY TYPE : RESIDENTIAL `_r•ona � �� 9�'-"�t��t',`�
CONSTRUCTION TYPE : PASS THROUGH FEES F�_e$�t��`'
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NOTE: THIS IS THE SEWER&WATER CONNECTION&SAC FEE FOR Pl
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APPLICANT SEWER CONNECTION CHARGE- WAYZATA 555.00
RYAN, STEVEN&ANNE WATER CONNECTION CHARGE- WAYZATA 2,020.00
25 MYRTLEWOOD RD
WAYZATA,MN 55391- S.A.C. 2,100.00
TOTAL 4,675.00
OWNER
RYAN, STEVEN&ANNE
25 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 addi[ional or related work which requires sepazate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified hercin.This permit will
expire and become null and void if construction authorized is not
commenced wi[hin 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 assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / , / /
Applicant Permitee Signature Date Issued By � ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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1 �
FOR CITY USE ONLY
' 0,��,�`O City of Orono Date Received: Permit#
`r P.O.Box 66
�,"`� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a� '1 ? p'' Crystal Bay,MN 55323
'� ��,a yG� (952)249-4600 Approved By(If Required):
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CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM
WAYZATA- SEWER&WATER PASS THROUGH CONNECTION FEES & SAC FEES
(ALL PERMITS-Mav be subiect to further review and mav not be issued when the ao�lication 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 INFORMATION
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: Pnor to the actual sewer or water connecrion permit(pulled by the
contractor)the payment will be held until 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 time 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 permit is issued, we will issue this permit and send you the
homeowner a copy.
TYPE OF PERMTT
(Check All That Apply)
Residenrial(May Require Approval)
New Connection ❑ Water Availability Connection For Future Hook-Up to Water
Job Site/ Owner Information:
Site Address: -r-i L ,,,., �_ �,� c v � �1�+
Owner: �� f 7�.c �� Mailing Address: � f"`
City: �`�rZi�` � � Zip: �S3�1 �
Home Phone: ��t��� ��3-' �S• -I Z Alternate Phone: (2 � 5 - � �:�
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, �r " DETERMININGr PER:MZ�':' EES
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;�SAC Charge(2009 Rate=�9A�A0) �Z � �=�-=' $ � , ((J c�
� �(SAC Charge must accompany all sewer pernut applications unless prep ia d
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
S�"S �
'`�Sewer Connection Ch e—City of Wayzata(Pass Through Fee) $ �
(2009 Rate=$�35:$9�;S�
�'ater Connection Cha " —City of Wayzata(Pass Through Fee) $ �� � � '"
(2009 Rate-$�;9�:@0�?�"L�j
)
❑ 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 installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connection Pernut is Issued:
1. Issue Water Meter&Horn Permit
2. Any Additional Connecrion Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee&Issue Water Connection Permit
TOTAL PERMIT FEE(Add Fees Listed Above) $ � ���
ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate 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 he applies to the City of Orono for issuance of a Utility Permit, agrees to do
all wark in strict ccq7-dance with the ordinances of the City and the regulations of the State of
Minnesota, a �,�ies that all statements made on this application are, true and correct.
Owner: Date: 7��S (� J
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