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I7ETCRMINING PERMIT FEES <br /> [] SAC Charge(2015 Rate—$2,485.00) � <br /> {SAC C'hargc must accoanpany alE sewer permit applications unless prepaid) <br /> (Urono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will nnt be issued} <br /> �— o�` <br /> (� Sewer Can ction/Disconnect!Repair(�50.00/Per Stub) $ �� <br /> � Pipe size � inches; material Y. Schd 40 air tested; cast iron <br /> � u <br /> �Water Connection/Disconnect/Repair($SU.UO/Per Stub} $ j� _ <br /> Pipe size ! inches;matei•ial _;K Schd 40 air tested; copper <br /> ❑Water Availability For�'uture Hook-Up ta Water($50.00) $ <br /> Water Availatrilitv Exnlanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works l�epartrnent. <br /> Required Before Watcr Connection Permit is Issued: <br /> 1. Issue Water Meter&Harn I'ermit <br /> 2, Any Additional Conriection Fees Paid(1f Applicable} <br /> Issue Water Connection Permit: <br /> 1. Cnllect Permit f�ee&.Issue Water Connection Pertnit <br /> i. SUBTO'['AL ofPermit fteyuested: $ � �� <br /> 2. S"TATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDL[NG(Only on Mail-tn Applications) $ 2.00�_ <br /> o '� <br /> 4. TOTAL PERMIT FE�(Add Lines 1-3 Above) $ 1 L� 7 <br /> �— ADDI'I'IONAL INFQRMATION—WATER METERS � —� <br /> ■ WA't'F.K MF.'I'ERS must be picked up and paid f<�r at Orono City Hall,these are on a senarate pennit. <br /> ■ WATER METEKS must be set and sealed by Orono Water Department (9S2) 249-4600, upon <br /> completiun of ineter installatian. <br /> The undersigned hereby applies;t�the C.ity of(�rono for issuance of a Utility Permit, agrees ta da <br /> all work in striet accordance w th the ordinances of the City and the regulations of the State of <br /> Minnesota, and ce ' es that all stai ents made on this application are,true and correct. <br /> � <br /> Applicant: Date: ' � � � " �S <br />