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r <br /> � DETERMINING PERMIT I'EES <br /> �AC Charge(2015 Rate=$2,485A0) $ <br /> (SAC Charge must accompany ali sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit wiil not be issued) <br /> t./L� <br /> Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ J� ' <br /> Pipe size `� inches;material�-I,�GSchd 40 air tested; cast iron <br /> �� <br /> (�Water Connection/Disconnect/Re air($50.00/Per Stub) $ �J� <br /> � � Pipe size�inches;material � �'��chd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availability Exalanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This 3ine will be inspected by the Public Works Department. <br /> Required Before Water Connection Pemut is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> ��� <br /> 1. SUBTOTAL of Permit Requested: $ j ��� <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 <br /> O <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ j L �— <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a seaarate 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 accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota,�fid certifies th t all �tatements made on this application are,trtte and correct. <br /> �._--- - _ <br /> Applican� , ,'�J Date: S- �5 — / `� <br /> / <br />