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� <br /> � F �W 4 _ ' �� �t 7 �S �C�3 y= • <br /> ,.�i;�'� .�,+F „�,z 'x ,yr"�. s!' � ��.e'� Ra`�x.�"l -`t _i+�'f�. <br /> ❑SAC Charge(2016 Rate=$2,485.00) $ <br /> (SAC Charge must accompany all sewer permit applicafions 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/Disconnect/Repair($50.0(I/Per Stub) $ <br /> Pipe size (.��inches;material Schd 40 air tested; cast iron <br /> �Water Connecdon/Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size�,, inches;material Schd 40 sir tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Eaplanation: <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. Issue Water Meter&Hom 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 /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STAT'E SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <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 sesled by Ornno Water Department (952) 249-46011, upon <br /> completion of ineter installation. <br /> T'he undersigned hereby applies to the City of Orono for issuance of a Urility Pernut,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 a11 statements made on this applicarion are,true and correct. <br /> � <br /> Applicant: �u.�..� (�n�n;�,; Date: � r�-- �b <br /> - � - <br />