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.� �7J�1 L�:�Z11Y111�t31�1�V r�i'l�V'Li 1 i"r.[�.S .. . . .. . � r <br /> a <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) �u <br /> � � <br /> [�Sewer Connectio /Disconnect Repair($50.00/Per Stuti) $ ��� <br /> Pipe size�inc es;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) $ <br /> Water Availabilitv Ezplanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> RecLuired Before Water Connecrion Permit is Issued: <br /> 1. Issue VJater Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connecrion Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> �� �� <br /> 1. SUBTOTAL of Permit Requested: <br /> $ > <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ • <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ `� � C`� <br /> ADDITIONAL INFORMATION-WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 of the City and the regulations of the State of <br /> Minnesota, and cer�'fi�s that all statements made on this application are,true and correct. <br /> Applican� "�� Date: � � �f_T_ <br />