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� �` ' <br /> . �. <br /> - r<- <br /> ❑SAC Chntge(2014 Rnte=52,485.00) $ <br /> (SAC Charge must accompany alt sewer permit applications unless prepaid) <br /> (Orono City Staff can deEermine if applicable) <br /> (If not prepAid,a sewer connecUon permit will not be iasaed) <br /> �Sewer Conaection/Disconnect/RepRir(S30i00/Per Stub) S <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> �f Connection/Disconnect/Repatr(SSO.OQ1Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Water Av�ila6tUty For Fatnre Hook Up to R'ater(S50.00) $ <br /> WAter AvAilabilitv Exalan�tion: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line wil!be inspected by the Public Works Department. <br /> Reauired Before Water Connection Petmit is Issued: <br /> 1. Issue Water Meter b'a Horn Pamit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Co�ect}�Q�Permit: <br /> 1. Collect Permit Fce&Issue Water Connection Pennit <br /> 1, SLIBTOTAL of Pamit Requested: � <br /> 2. STAT�SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLAVG(Only on Mail-In Applications) $ 2,pp <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) g <br /> ADLITF�O�TAL IlVF4R11�+I�TION—�ATER'METF.1tS <br /> • WATER METERS must be picked up and paid for at Orono City Hall,these aze on a separate permit. <br /> • WATER METERS mnst be set And sealed by Orouo Water DepAtrtment (952) 249-4600, upon <br /> completlon of inete.r instAflxtton. <br /> The undersigned hcreby applies to thc City of Oronv for issuance of a Utility Permit, agrees to do <br /> all work in strict accordanee with the ordinances of We City and the regularivns of Che State of <br /> Minuesota,and certifies tl�at all statements made on this application are,h ue aud coirect. <br /> . <br /> Applicant: "� <br /> Date: �D-lo-�O� <br />