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PETITION, WAIVER AND AGREEMENT FOR PAYMENT OF THE COST OF <br />INSTALLATION AND CONNECTION OF, OR REPAIRS TO, PRIVATE UTILITY LINES <br />AND ASSESSMENT OF AMOUNTS PAID AS A SPECIAL CHARGE UNDER <br />MINNESOTA STATUTES, SECTION 429.101 <br />TO: City Council of the City of Elk River <br />D©ugl.9s M. N45on +'fillsYQ 4415 01Z (theOwners), owners of the property <br />located at j I -� 6 d Mer+O I k Si • N 'vVy and legally described on <br />Exhibit A attached hereto (the Property), <br />Petition the City of Elk River (the City) to pay the costs of installation and connection of, or <br />Repairs to, (the Work) private utility lines located on the Property or in the Right -of -Way <br />directly adjacent to the Property, including: <br />Installation and connection of private water service lines <br />Installation and connection of private sanitary sewer service lines <br />Repair of private water service lines <br />Repair of private sanitary sewer service lines <br />In an amount not to exceed that set forth on Exhibit B attached hereto (Cost of the Work); and, <br />To levy a special assessment against the Property as an unpaid special charge pursuant to <br />Minnesota Statutes, Section 429.101 in the amount of the Cost of Work plus the total of the <br />following charges (if Applicable):. <br />1 <br />V21 L� q 1.00 <br />Cost of the Work (from Exhibit B) <br />4, 6 3 S X Q <br />Sewer Access Charge (fill in current year fee) <br />$3,532-19 <br />Water Access Charge (fill in current year fee) <br />r S I 00.00 <br />Trunk/Lateral Charges (to be determined based on <br />costs to provide services) <br />TOTAL ASSESSMENT AMOUNT <br />(Sum of all listed amounts) <br />