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�R _ y <br /> I <br /> I <br /> ❑SAC Charge(2016 Rate=$2,485.00) $ <br /> (SAC Charge must accompany all sewer pe it applications unless prepaid) <br /> (Orono City Staff can determine if applicab ) <br /> (If not prepaid,a sewer connection permi will not be issued) <br /> �,Sewer Connection/ �sco /Repair($ .00/Per Stub) $ S� <br /> Pipe size inc es;mater�al Sch 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repair($ 0.00/Per Stub) $ <br /> Pipe size inches;material Sch 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to ater($50.00) $ <br /> Water Availabilitv Explanation: <br /> Contractor installed line to inside of house fo future hook-up. <br /> This line will be inspected by the Public Wor s Department. <br /> R uired Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Pai (If Applicable) <br /> Is�ue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water C nnection Permit <br /> 1. SUBTOTAL of Permit Requested: I $ �• �O <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In A plications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above� $ S"� • o t� <br /> ' �DI'�'� ,��Il1T�t��t�l��'i� �� ° , � v <br /> ■ WATER METERS must be picked up and paid for at Qrono City Hall,these are on a senarate nermit. <br /> ■ WATER METERS must be set and sealed by Orodo Water Department (952) 249-4600, upon <br /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Orono fo issuance of a Utility Permit,agrees to do <br /> all work in strict accordance with the ordinances of th City and the regulations of the State of <br /> Minnesota,and certifies that all statements made on thi application are,true and correct. <br /> Applicant: Date: 3 / <br /> � <br />