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� � �, <br /> .. <br /> , D�T ' .. , _ ; ��':� _ <br /> ❑SAC Charge(2015 Rate=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) <br /> ❑Sewer Connection/Disconnect/Repair($50.00/Per Stuti) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repsir($50.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 sir tested; copper <br /> ❑Water Availability For Fnture Hook Up to Water($50.00) � <br /> Water Availabilitv Ezulaaation: <br /> Contractor installed line to inside of house for fuwre hook-up. <br /> This line will be inspected by the Public Works Depamment. � <br /> Required Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter 8c 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 S 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applicarions) S 2•00___�__ <br /> �1�> l <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � �� �• V v <br /> ADDITIONAL INFORMATTON-Vi�ATER METERS <br /> � WATER METERS must be picked up and paid for at Orono City Hall,these are on a seuarate 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 with the ordinances e Ci the regulations of the State of . <br /> Minnesota,and certifies that a ements e this i 'on are,true and correct. <br /> r- z- r g <br /> Applican • Date: <br />