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s" <br /> , . .. ,,,.� .. <br /> 'Y� r x�i��b°�vK��Y.�K'� }5� .,.,,� .. . , � ; -� s.�.. <br /> � <br /> � � <br /> ❑SAC Chatge(2016 Rate=$2,485.00) $ <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 Issaed) <br /> ❑Sewer Connection isconnect Repair($50.00/Per Stub) $ �V <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑Wster Connection 'sconnec Repair(550.00/Per Stab) $ �� <br /> Pipe size inches;material Schd 40 sir tested; copper <br /> ❑Water Availability For Fbtare Hook-Up to Water(S511.00) $ <br /> Water Availabilitv Ezalanation: <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&f�NDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMiT FEE(Add Lines 1-3 Above) $ L V � . <br /> ADDITIONAL INFORMATION—WATER METERS <br /> • WATER METERS must be picked up and paid for at Orono City Hall,these are on a se arate permit. <br /> ■ WATER METERS must be set and sesled by Orono Water Department(952)249-4600, upon <br /> completion of ineter installation. <br /> The undersigned hereb applies to the City of Orono for issuance of a Utility Permit,agrees to do <br /> all work in stric o e with the ordinances of the ' and the regulations of the State of <br /> Minnesota,and rtifies t all sta.tements made ' ap ication are,true and correct. <br /> Applicant: Dat+�.` '� <br />