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PETITION, WAIVER AND AGREEMENT FOR PAYMENT 1= 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 />�(the Owners), owners of the property <br />........... .... <br />Co o el <br />located at 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 />n. <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 />Lf 7 0 000 Cost of the Work (from Exhibit B) <br />Via' , o 0 - Sewer Access Charge (fill in current year fee) <br />2,. "11 — Water Access Charge (fill in current year fee) <br />o 0 , o u <br />4-Z Trunk/Lateral Charges (to be determined based on <br />costs to provide services,) <br />7� 'S <br />TOTAL ASSESSMENT AMOUNT <br />(Sum of all listed amounts) <br />