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Home My WebLink About2009-00922 - water pass through fees CITY OF ORONO PERMIT NO.: 2009-00922 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEn: 12/3U2009 952 249-4600 FAX: 952 249-4616 REPRINTED ON 12/31/2009 ADDRESS : 50 MYRTLEWOOD RD PIN : 36-118-23-33-0006 `LEGAL DESC : REG.LAND SURVEY NO. 0446 : LOT 000 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : PASS THROUGH FEES NOTE: THIS IS THE WATER CONNECTION FEE FOR PERMIT#2009-00923 SEWER CONNECTION&SAC WAS ON PERMIT#2009-00921 PAID VIA:STEVEN CIIAMPLIN CK 19374 APPLICANT WATER CONNECTION CHARGE-WAYZATA 1,920.00 CHAMPLIN,MR.&MRS. TOTAL 1,920.00 50 MYRTLEWOOD RD WAYZATA,MN 55391- OWNER CHAMPLIN,MR.&MRS. 50 MYRTLEWOOD RD WAYZATA,MN 55391- AGREEME1vT 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 pertnit is for only the work described and does not grant permission for additional or related work which requires separate permits. 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 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. l � FOit GIT'Y�3SE ONLY ;, O,¢p�,O City of Orono llateiteceivad: F�mmic# P.O.Box 66 2750 Kelley Parkway [�in-�Iou�e$A�I�eCtCrtYlination Fmm Compteteti _ � � � Crystal Bay,MN 55323 � (952)249-4600 Approved�3y(�f R�qt►ired): - CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM WAYZATA-SEWER&WATER PASS THROUGH CONNECTION FEES& SAC FEES (ALL PERMI'1'S-Mav be subieM to further review and mav not be issued when the aoolication is received) PERMIT CODES(IN-HOUSE) Sewer/Residen[ial/Pass Through Fees/Blank Water/Residential/Pass Through Fees/Blank Sewer&Water/Residendal/Pass Thmugh Fees/Blank �Er��n�a��orr 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 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 addirional 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 UF PERMIT Check All T�at A 1 ❑Residential(May Require Approval) ❑New Connection ❑ Water Availability Connecrion For Future Hook-Up to Water Jab Site f Owner Iriformation: ° Site Address: J�4 /ntir�-/ec��o� o� Owner: �.K��s� Mailing Address: �� q� c�ty: lu�� z�p: 5s3g� Home Phone: �JrZ ' �73-�d'9g Alternate Phone: �� 41 t�'�a/1'�c4�"n� i � �SAC Charge(2009 Rate=$2,000.00) $ a�OD. �0 (SAC Charge must accompany all sewer permit applicarions 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) $ ��J. O� (2009 Rate=$525.00) • �Water Connection Charge—City of Wayzata(Pass Through Fee) $ �� a� • �� (2009 Rate-$1,920.00) ❑ Water Connection Opt-Out—(Please Initial) I am choosing not to hook-un to water at this time. ❑ Water Availability— (Please Initial) I am choosing not to hook-uu to water at this time. I have chosen to have my contractor make it water available for future hook-up. Water Availabilitv Eaplanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connecrion Pemut is Issued: 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 D � TOTAL PERMIT FEE(Add Fees Listed Above) $ �� AD�7ITIONAL INFC�kMATIC}N-WA'I'ER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. Typically the contractor will pick-up and pay for this permit. ■ WATER METER5 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: