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Home My WebLink About2012-00152 - water connection pass through fee � CITY OF ORONO * z 0 1 z - 0 0 1 5 2 * - 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 30 MYRTLEWOOD RD PIN : 36-118-23-33-0011 LEGAL DESC : MYRTLEWOOD : LOT 003 BLOCK 001 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : PASS THROUGH FEES NOTE: THIS IS THE WATER CONNECTION FEE FOR PERMIT#2012-00144 SEWER CONNECTION&SAC WAS ON PERMIT#2009-00847 PAID VIA:LORI PAULSON CHECK#13571 APPLICANT WATER CONNECTION CHARGE-WAYZATA 1,122.00 PAULSON,BRUCE&LORI TOTAL 1,122.00 30 MYRTLEWOOD RD WAYZATA,MN 55391- OWNER PAULSON,BRUCE&LORI 30 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 permits. All provisions of laws and ordinances governing 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 assuring all required inspections are 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 Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � . �c��c�t�s�ot�.�� r� �p�, City of Orono l��Rec��ed �� i�epnrt� � ._ . O O P.O.Box 66 ` 2750 Kelley Parkway O 1n-T�Tp�e��1�pete�m�naqqn�t�rm�qt�lplefet� E,, �'' Crystal Bay,MN 55323 � �� " � � (952)249-4600 AppCtt�Bd�3��I�'R�jp�d� `�sr� � � � � �� CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM WAYZATA-SEWER& WATER PASS THROUGH CONNECTION FEES& SAC FEES (ALL PERMII'S-Mav be subiect to further review and mav not be issued when t6e aonlication is receivedl PERMIT CODES(IN-HOUSE) Sewer/Residential/Pass Through Fees/Blank Wated Residential/Pass Through Fees/Blank Sewer&Water/Residential/Pass Through Fees/Blank G'rE1�tERi�:G Th7FC�II�MMATit'�N 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 until that permit 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. �.:� � �� _ : T�'PEFQF FERIvIIT ` ; : Ghec�;All Tha�.A 1 ❑Residential(May Require Approval) ❑ New Connection [�Water Availability Connection For Future Hook-Up to Water Job Site/.Qwr�er Inf�rma.t�.c�n. : ; �. `. Site Address: ,�Q �'�C vCA,Jnp� � Owner:1�,��C t��cp ,�"/��T,�,v�j1� Mailing Address: � � �, City: WD Zip: �53� � Home Phone: �52-- T��—��'� Alternate Phone: �'SZ-3$�0- g 3 7 � .• ' , ❑ SAC Charge(2012 Rate=$2,365.00) $ (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) $ (2011 Rate=$590.00) �ater Connection Charge—City of Wayzata(Pass Through Fee) $ �� -�-- .C'�� (2011 Rate-$1,122.00) ❑ Water Connection Opt-Out—(Please Initial) I am choosing not to hook-ua to wafer 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 Exalanation: 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 Permit is Issued:�j p,O O 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit TQTAL PERMIT FEE(Add Fees Listed Above) $ I � I �� ' AL�D�TIt�1��;=;Th�'F�}�IATIUI�-'�ATER.�IET�RS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a se�arate permit. 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. Owner Date: �—C'�