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Y <br /> � <br /> . ... . " . �����a..�J'y�V i J.I+�+*+s 1 � -. . . . ., � <br /> ❑ SAC Charge(2015 Rate=52,485.00) $ <br /> (SAC Chazge 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) <br /> ❑Sewer Connection/Disconnect/Repair($50.00/Per Stuli) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) S <br /> Water Availabilitv Eanlanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Ra uired Before Water Connection Permii is Issued: <br /> l. Issue VJater Meter&Horn 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. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines l-3 Above) $ <br /> ADDITIONAL INFORMATIOi�T-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 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 wi�k�the ordinances af"t�ie City ar�d the regulations of the State of <br /> Minnesota, and certifies that all statements made on this app�ication are,true and correct. <br /> !�' <br /> Applicant: , <br /> ` Date: � Z � �� � <br />