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10!19l2017 10:54 FinalGrade �A3�952 492 5101 P.0031006 <br /> ]aE'��R�VlIN�NG PERIVIIT FEES <br /> ❑SAC Charge(2015 Rate=$2,485.00) S <br /> (SAC Charge must accompany all sewer pennit a�pIicstions un[ess prepaid) <br /> (Orono City Staff can dettrmine if applicable) <br /> (If not prepsid,a sewer conneck�on permit wlll not be isruod) <br /> �Sewer Coanection/Disconnect/Repair(550.00/Per Stub) S�•� <br /> Pipe siu �} inches;material�Schd 44 air tested; cast iron <br /> ❑Water Connectioa/Disconnect/Repair(S50.00/Per Stub) $ <br /> Pipe siu inches;maurial Schd 40 air tested; copper <br /> ❑Water Aveilsbility For Future HooIHCJp to Water(550.04) $ <br /> Water Ar�allabilitv���lanatton: <br /> Contractor inst�lled line to inside of house for future hoofo-up. <br /> This line will be inspected by the Public Works Departmen� <br /> Required Before WatetConnection Permit is Issued: <br /> i. Issue Waur Meter 8c Horn Permit <br /> 2. Any Additional Connoction Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> l. Collect Permit�'ee&Issue Water Connection Permit <br /> 1. 3UBTUTAL of Aermit Requ�ted: �� . � <br /> 2. STATE SURCHARGE S 1.00 <br /> 3. POSTAf3E dt HANDLING(Only on Mail-In Applicatiorts) $ 2.Ob <br /> 4. TOTAY.PE�'Y'FEE(A,dd Lines l-3 Above) S �• � <br /> anDi�orraL nvFORMArroN-wAT��.��Rs <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall�these are on a senarate nermit <br /> � 'VVA?�R METERB must be set a�d sea�ed by Orono Weter Departmen!(952) 249-4600,upon <br /> completion of ineter installation. <br /> The undersigned her�by applies to the City of Orono for issuance of a Utility Permit,agrees to d� <br /> all work in striat accardance with the ordinances of the City and the reg�alations of the Stats vf <br /> Minnesota,and certifies that all s rnents made on this application are,true and carrect. <br /> � <br /> Applicant: Date: �� �� <br /> �,e.',�.��e.��-.� <br />