ࡱ> vxu @ KbjbjFF ,d,,:,8,,U5K D!-#-#-#-7Z-04 6R]8v4up#p#p#45+++p#!-+p#!-++a++ P/~^'y+,L%50U5+8'8+,,8+L =!|+!d"S 44,, 0 *,,0 LATERAL EXTENSION CHARGE WORKSHEET Log No.:  FORMTEXT       Date:  FORMTEXT        FORMCHECKBOX  Jefferson County  FORMCHECKBOX  Crestwood  FORMCHECKBOX  Oldham County Sanitation District  FORMCHECKBOX  Prospect Applicant s Name/Address Development Name/Location  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Record No./L.E. No.:  FORMTEXT       Telephone No.:  FORMTEXT       PSC Work Project No.:  FORMTEXT       Section  A : Capacity Charges If property is exempt, check one of the following: 1. Development previously served by a non-MSD sewer system or by an on-site disposal system.  FORMCHECKBOX  2. Property within the City of Louisville (1947) Boundary.  FORMCHECKBOX  3. Property owned by the City of Louisville or Jefferson County or their agencies.  FORMCHECKBOX  4. Property within an Enterprise Zone established pursuant to KRS 154.  FORMCHECKBOX  5. Property does not require a connection or an extension of MSDs sewer system.  FORMCHECKBOX  6. Property exempted by special agreement. (eg. Beckley Trace)  FORMCHECKBOX  Capacity Charge Calculation for Non-Exempt Properties: 1)  FORMTEXT       (units or lots) x  FORMTEXT       Single Family Eq. Factor x $ FORMTEXT       Flat Fee (each) = $ FORMTEXT       2) $ FORMTEXT       Capacity Charge x  FORMTEXT       Gallons per Day (GPD). = $ FORMTEXT       3) Mixed use development, Capacity Charge per attached work sheet. = $ FORMTEXT       4) a) Joint Venture Participation Based on Estimated Use of Design Capacity $ FORMTEXT       Capacity Charge x  FORMTEXT       Estimated Gallons per Day (GPD). = $ FORMTEXT       (a) b) Prorated Construction Cost Contribution (per attached). = $ FORMTEXT       (b) NOTE: The financial contribution shall be the greater or either 4a or 4b Total Capacity Charge ( FORMTEXT      )  Single Family Equivalent = $ FORMTEXT      * *A Letter of Credit for this amount will be accepted by MSD until the sewer is available. A draw on the letter of credit will be made at that time OR a certified check will be required. Section  B : Pump Station Telemetry Reimbursement Calculation: Revenue Account No.:  FORMTEXT       1) Pump Station Telemetry Reimbursement = $ FORMTEXT       2) Other (*JLNP\^`dfz|~ȿr`WP hT5CJh?!vh7CJ"jh'8CJUaJmHnHu#j hThTCJUaJhTCJaJjhTCJUaJh?!vh*)CJ hTCJh?!vh0CJh?!vh05CJ hWX5h?!vh?!vCJ h?!v5CJh?!vh?!v5CJh?!vh?!v5CJh?!vh?!v5CJaJh?!vh0jh0ULNP  B \ ^   _6 !@gdWXgd 4dhgd9 4dhgd9  dhgd7dh$a$gd?!vKK  < > @ B T b d q_"jh'8h'85CJU"j&h'8h'85CJUh?!vh05CJ"j h'8h'85CJUjh?!vh*)5CJUh?!vh*)5CJh?!vh*)CJh?!vh05>*CJaJ"jh'8CJUaJmHnHujhTCJUaJ#jH hThTCJUaJ  6 f n  ˵˵}q_}qPEh4jhyCJaJjh4jhyCJUaJ#jh{0#h{0#CJUaJh?!vh*)5CJaJ"jh'8CJUaJmHnHu#jh{0#h{0#CJUaJh{0#CJaJjh{0#CJUaJh?!vh05>*CJh?!vhD%5CJh?!vh05CJh?!vh*)5CJjh?!vh*)5CJU"jh'8h'85CJU     0 2 4 > @ B D X Z \ f h j ޵ޘ~l̉aVJBhTCJaJjhTCJUaJh?!vhCJaJh?!vh0CJaJ#jRhThyCJUaJhThyCJaJjhThyCJUaJh?!vh*)CJaJ#jh4jhyCJUaJh4jhyCJaJh?!vh*)5CJaJ"jh'8CJUaJmHnHujh4jhyCJUaJ#jVh4jhyCJUaJ    0 4 6 J L N X Z \ ^ z ĹϪĹyg\WMCh?!vh5CJh?!vh05CJ hn5h?!vh0CJaJ#jhThTCJUaJhTCJaJh?!vh5CJaJ#j:h4jhCJUaJh4jhCJaJjh4jhCJUaJh?!vhCJaJh?!vhU]CJaJ"jh'8CJUaJmHnHujhTCJUaJ#jhThTCJUaJ    EFGUVW^-./ž~sj|h'8Ujh'8Ujh'8Uhhh05j h'8UjhUh h^lh0 h?!vh?!vh h?!vh h?!vh0h?!vhPa6CJh?!vhTO6CJh?!vh06CJh?!vh6CJ(jxz踱vd] h^lh"jh'8CJUaJmHnHu#jhTh|CJUaJhTh|CJaJjhTh|CJUaJ h^lh0h^lh05 h^lh?!vh!!hTOjdh'8UhhPa h^lhF h^lh!! h^lhU]hjhUjh'8U!6lnz2.lnprtgd^lgdTO !dhgd| !dhgd?!vdh !dhgdXx !dhgdXx !dhgdXxgd&(<>@JLntv޺ޤœs`QFhThfElCJaJjhThfElCJUaJ%jh'8>*CJUaJmHnHu&j(h4jhl*>*CJUaJh4jh7>*CJaJ jh4jh7>*CJUaJhXx#jhTh|CJUaJhTh|CJaJ h^lh0"jh'8CJUaJmHnHujhTh|CJUaJ#jDhTh|CJUaJ RThjlvx   "Ŷ̶ńxdQńx=&jh4jhl*>*CJUaJ%jh'8>*CJUaJmHnHu&jh4jhl*>*CJUaJh4jh7>*CJaJ jh4jh7>*CJUaJh#jhTh|CJUaJhTh|CJaJjhTh|CJUaJ h^lh0"jh'8CJUaJmHnHujhThfElCJUaJ#jhThCJUaJ"$.068:NPR\^`dƻƗՓyg\XLh4jh7>*CJaJhXxh5>*CJaJ#jhTh|CJUaJhTh|CJaJjhTh|CJUaJh"jh'8CJUaJmHnHu#jzhThl*CJUaJhThl*CJaJjhThl*CJUaJ h^lh0%jh'8>*CJUaJmHnHu jh4jh7>*CJUaJfh|~.8DVbfh|~ۮvj[P>#jRhTh?!vCJUaJhTh?!vCJaJjhTh?!vCJUaJhTOhTO5CJaJhTOhU5CJaJhTOh05CJaJhTOh^lh05&jh4jhl*>*CJUaJh4jh7>*CJaJ h^lh0 h^lh%jh'8>*CJUaJmHnHu jh4jh7>*CJUaJ&j^h4jhl*>*CJUaJ~bjlnprvɾ~kgcg\XTMF h?!v5CJ h^lh?!vh?!vh^l h^lhTOhPahTO%jh'8>*CJUaJmHnHu&jh4jh>*CJUaJh4jhfEl>*CJaJ jh4jhfEl>*CJUaJhh0hTOhh0CJaJhthtCJaJht5CJaJhTOhTO5CJaJ"jh'8CJUaJmHnHujhTh?!vCJUaJtvHJ2<<<<<<T=h=>d?h?@ANBBC 2 \ <@@@@gd` 2 \ @@@gd`dhgd gd @ !@@dhgdfEldhgd^lgd^lv "68:DFH< < < <"<$<μ֪룟n[YE&j.h4jhl*>*CJUaJU%jh'8>*CJUaJmHnHu&jh4jhl*>*CJUaJh4jh7>*CJaJ jh4jh7>*CJUaJh^l h^lh^l"jh'8CJUaJmHnHu#jJhThTCJUaJhTCJaJjhTCJUaJh?!vh^lCJh?!vh^l5CJh?!vh5CJ = $ FORMTEXT       Total Telemetry Charge:  FORMTEXT       = $ FORMTEXT       Section  C : Recapture Charge Calculation for Non-Exempt Properties: Check One Host, LLC  FORMCHECKBOX  Brush Run, LLC  FORMCHECKBOX  Oakland Hills, LLC  FORMCHECKBOX  Cox, LLC  FORMCHECKBOX  Ridge Partners, LLC  FORMCHECKBOX  10008131 10008239 10008710 10008709 10008606 1)  FORMTEXT       (units or lots) x  FORMTEXT       Single Family Eq. Factor x $ FORMTEXT      Flat Fee (each) = $  FORMTEXT       2) $ FORMTEXT       Recapture Charge x  FORMTEXT       Gallons per Day (GPD). = $  FORMTEXT       3) Mixed use development, Recapture Charge per attached work sheet. = $  FORMTEXT       4) a) Joint Venture Participation Based on Estimated Use of Design Capacity $ FORMTEXT       Recapture Charge x  FORMTEXT       Estimated Gallons per Day (GPD). = $  FORMTEXT       Prorated Construction Cost Contribution (per attached). NOTE: The financial contribution shall be the greater or either 4a or 4b Total Recapture Charge $  FORMTEXT       MSD (45201-5000000) $  FORMTEXT       Recapture Remittance (23275-1000000) $  FORMTEXT       Total of All Charges due MSD $ FORMTEXT       Remarks:  FORMTEXT       Prepared by:  FORMTEXT       Date  FORMTEXT       Approved _______________________________________________________________ Date __________________ Engineering Division Signature Sent to Applicant by________________________________________ Date _________________ For Customer Relations Use Payment Confirmation: Method of Payment:______________________________________ Amount $_______________ ___________________________________________________________________________ Date __________________  FILENAME LE_CapacityCharge.dot Form Rev. 10/24/2007 $<.<0<2<4<`<f<h<j<~<<<<<<<<<<<<<<<ĻthTPLE h^lhhTOh^l&j$h4jhl*>*CJUaJh4jh7>*CJaJ"jh'8CJUaJmHnHu#jhThCJUaJhThCJaJjhThCJUaJh;5CJaJhT5CJaJhTOh^l5CJaJhfEl h^lh^l jh4jh7>*CJUaJ%jh'8>*CJUaJmHnHu<<=N=P=T=^=h=p=r=~===============> >">>>@>B>F>H>X>\>^>z>|>~>>>>>>>¾ƾ¾~zrzjh`Uh`hj h'8Ujh'8Ujh'8Uhtjh'8UhjhUhh h^lh h^l5 h5h?!vhu[5CJh?!vhU5CJh?!vh 5CJh?!vh5CJ,>>>>>>>?@?P?R?b?d?f?h?r?t??????????????"@$@8@:@<@ƷzhzV#j!hTh|CJUaJ#jV!hTh|CJUaJ h^lh h^lh"jh'8CJUaJmHnHu#j hTh|CJUaJhTh|CJaJjhTh|CJUaJ hTh hTh^l>* h`h`h`hthTOh^ljh`Ujv h'8U!<@F@H@t@v@@@@@@@@@@@@@@@AAAA Aǻǔ؅zhYN*CJUaJmHnHu&j:"h4jhl*>*CJUaJh4jhl*>*CJaJ jh4jhl*>*CJUaJ h^lh jhTh|CJUaJ"jh'8CJUaJmHnHu AbAdAxAzA|AAA&B(BB@BJBLBBBCCCC C$CLCNCbCdCfCpCrCCܡuc_Mc#j%hTh|CJUaJh&rr"jh'8CJUaJmHnHu#j$hTh|CJUaJhTh|CJaJjhTh|CJUaJ&j$$h4jhl*>*CJUaJ%jh'8>*CJUaJmHnHu&j#h4jhl*>*CJUaJh4jhl*>*CJaJ jh4jhl*>*CJUaJ h^lh CCCCCCClDvDEEEE0E4E6E:E*CJUaJhPah; h^lhU]hTOhU]CJaJhTOhU]5CJaJhPa5CJaJh^lh 5 h^lh %jh'8>*CJUaJmHnHu&j%h4jhl*>*CJUaJh4jhl*>*CJaJ jh4jhl*>*CJUaJChDEbEdEEETFVFFFFGGNHHFIHIJII &dP @dhgd`dh dh^gdTOgdTO`gd20gd^gdPadhgd & Fdhgd EEEEEEEE"F&F(F,F.FBFDFFFPFRFTFVFbFpF|F~FFFF۽ۘۀtht\PGhTO5CJaJhTOhTO5CJaJhTOhD%5CJaJhTOhIM5CJaJhTOhU5CJaJhU]&j&h4jhl*>*CJUaJh4jhl*>*CJaJh;hPahTOhTO5hTO h5hTO5>*CJaJ%jh'8>*CJUaJmHnHu jh4jhl*>*CJUaJ&jv&h4jhl*>*CJUaJFFFFFFFFFFFFFFFFFFFGGG G4G筦qhWKh4jh>*CJaJ jh4jh>*CJUaJh,h0CJ &j'h0]h>*CJUaJh0]h>*CJaJ jh0]h>*CJUaJh h^lh0 h^lh %jh'8>*CJUaJmHnHu&jj'h4jhl*>*CJUaJh4jhl*>*CJaJ jh4jhl*>*CJUaJhPah)4G6G8GBGDGFGVG`GbGvGxGzGGGFIHIJI~IIIKKK,K.KXKZKKȬzrjb[SOSFSOh pLmHnHuh pLjh pLU h^lh{h^lh05h?!vhIM6h?!vh?!v6hjh?!vCJhjhIMCJ &j(h4jhWX>*CJUaJh4jhWX>*CJaJ jh4jhWX>*CJUaJh h^lh0%jh'8>*CJUaJmHnHu jh4jh>*CJUaJ&j`(h4jh>*CJUaJIINJK\KKKKKgd{mRgd{dhKKKKK h^lh{h-h pL h{mRh pL*:p|/ =!"@#@$@%@@ DdX (#x<  C AbN 0,f.1x5Z* Dn" 0,f.1x5ZPNG  IHDRXgAMAPLTEٟ pHYs+ IDATxn`FEt!_@/YkQZvs `D |mc  |i'bv72rma$E"E('Nzg_[U7If$eIbI{dUѵY4ES>#{INuiRBSѾrV.XUQ}}є&hO g5Π^gϪKD(`򉰊-T$͛uEP]=U\$p^4˱jֱf]YS4;\mڏE.,Rtճiw.j(jО)nWYbGlt|Mb9! 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