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DET�;RMINING PERMIT rEES <br /> ❑SAC Charge(2015 Rate=52,485.00) S <br /> (SAC Charge must accompany all sewer permit appiications unless prepaid) <br /> (Urono City Staff can determine if applicable) <br /> (If not p�•epaid,a sewe�•cunnection permit will not be issued) <br /> �Sewer Conne•tion/Disconnect/Repair(�50.00lPer Stub) $ <br /> `�� f � <br /> Pipe size�inches;material � Schd 40 air tested; cast iron <br /> �� c..� <br /> (�]Water Conn�ction!Disconnect!Repair($SO.00/Per Stub) � <br /> Pipe size inches;materiai_`� Schd 4U air tested; capper <br /> ❑ Water Availability For x'uture Hook-Up ta Water($50.00) $� � <br /> Water Availabilitv Explanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be ins}�ected by the Public Works I�epartment. <br /> Requircd Before Wntcr Conricctian Pennit is Issued: <br /> 1. (ssue Water Meter&Florn I'ennit <br /> 2, Any Additianal Com�ection Fees Paid(If Applicable) <br /> Issue Water Connection Pennit: <br /> l. Collect Permit Fee&Issue Water Connection Permit <br /> j c � <br /> I. SUBTOTAL of Permit Requested: $ l �d <br /> 2. STATE SURCHARGE � 5.00 <br /> 3. PO5TAGE&HA?�TDLTNG(Only on Mail-In Applications} � 2.00__ <br /> c+ .� <br /> 4. TOTAi.PERM.['I'F'EE(Add Lines 1-3 Above) $ j f-' 7 <br /> _ _- - ------------------- --� <br /> ADDIT'IONAL INF4RMATION—WATER 1vIETERS <br /> ■ WATF.R METERS must be picked up and paid for at Orono City Hall,these are on a senarate�errnit. <br /> ■ WATER MF,TERS must be set and sealed by Orono Water Department (952) 249-4600, apon <br /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Orono for issuance�f a Utility Permit, agrees to da <br /> all work in strict accordanc with the ordinances of the City and the regulations of the State of <br /> Minnesota,and c ifies that 'll s tements made on this application are,true and correct. <br /> Applicant: Date: � �"2� - � 5 <br />