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�. : �� �� � � :n �. ,� • <br /> ; ���=,���, ����s�} 4. �� K a <br /> ❑SAC Charge(2015 Rate=52,485.00) $ <br /> (SAC Charge must accompany all sewer pernut applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> [�Sewer Connection isc nect Repair(550.00/Per Stnb) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> [�,Water Connection Disconnect Repair($50.00/Per 5tub) $ <br /> Pipe size inc es;materia Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) S <br /> Water Availabilitv Egolanadon: <br /> Contractor installed line to inside of house for future hook-up. <br /> 1'his line will be inspected by the Public Works Departrnent. <br /> Required Before Water Connection Permit 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 Pernut Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) S <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 aet 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,and certifies that all statements made on this application aze,true and correct. <br /> Applicant: ,� r�,d Date: �cl-.'' c�.� �� <br />