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DETERMINING PERMIT FEES <br /> ❑ SAC Charge(2015 Rate=$2,485A0) $ <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> �c <br /> �Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ ��% <br /> ' Pipe size " inches;material 5�h yG Schd 40 air tested; cast iron <br /> �b�> <br /> (�Water Connection/Disconnect/Re air($50.00/Per Stub) $ �� � <br /> , <br /> � Pipe size � inches;material ���Schd 40 air tested; copper <br /> ❑Water Availability Fur Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Exalanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Required Before Water Connection Permit is Issued: <br /> 1. tssue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&lssue Water Connection Permit <br /> �L <br /> 1. SUBTOTAL of Permit Requested: $ � �� <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLTNG(Only on Maii-Tn Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � �i-I �-�= <br /> � ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. <br /> ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordartce with the ordinances of the City and the regulations of the State of <br /> Minnesota,an,�t certifies thJat al�statements made on this application are,true and conect. <br /> / i <br /> Applicant: Date: � �/ S - ) 5 <br />