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1 � •� <br /> � , . <br /> ❑SAC Charge(2016 Rate�$2,485.00) $ <br /> (SAC Charge must accompany all sewer�it applieations unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connect�n permit w�l not be issned) <br /> �Sewer Conn ion/Disconaect/Re air(550.00/Per 3tub) $ .�a� <br /> P�pe size�inches;material Schd 40 air tested; cast iron • <br /> r <br /> �Wster Connection/Disconnect!Re sir(550.00/Per Stub) $ ��� <br /> Pipe size 1_inches;material�Schd 40 air test�l; copper , <br /> ❑Water Availability For Future Hook Up to Water($50.00) $ <br /> Wster Avaitabilitv E:olanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> $gguired B�ore Water Connection Permit is Issued: <br /> 1. Issue Water Meter&Hom Pennit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> L�ue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Request�: $ l d�.�p <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE 8c HANDLING(Only on Mai1-In Applicatirnns) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lin�1-3 Above) S ��(•d� <br /> ADDITTO�TAL Il�1F'ORI�4 T�0�1'—WATER METERS � <br /> � WATER METERS must be picked up and paid for at Orono City Hall,these are on a�enarate R6rmlt <br /> ■ WA1'ER METERS must t►e aet and �eAtcd by Orono Water Department (952) 249-4600, npon <br /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Qrono for issuance of a Utility Pennit,agrees to do <br /> all work in s�trict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota,and certifies that all stat made on this application are,hue�d corre�t. <br /> Applicant� Date: 2"� �'! '' � ` <br />