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.� <br /> . ` <br /> v <br /> .. . . , <br /> D�T����.�TCi�P�'�'FE� <br /> ❑SAC Charge(2015 Ratc=52,485.00) $ <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) �0 <br /> ❑Sewer Connection/Disconnect/Repair($SO.00Rer Stuli) S �� � <br /> pipe size inches;material�_Schd 40 air tested; cast uo <br /> ❑Water Connection/Disconnect/Repair($50.00/Per Stub) S <br /> Pipe size inches;materisl Schd 40 air tested; copPCr <br /> ❑Water Availability For Future Hook Up to Water(550.00) � <br /> Water Availabilitv Ezolanstion: <br /> Contractor installed line to inside of house for firture hook-up. <br /> This line will be inspected by the Public Works Department. � <br /> Required Before Water Connec�Qn Permit is Lssue.�i: <br /> 1. Issue Water Meter 8c Horn Permrt <br /> 2, Any Additional Connection Fees Paid(If Applicable) <br /> T��ue Water G�*��ection Pennit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: � <br /> 2. STATE SURCHARGE S 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 1N�ORMATIO�T-R�ATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a�gparate permit. <br /> ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion o!meter installatiou. <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 are,trve and correct. <br /> Appli t: ,�. -- Date: ld- �- � � <br />