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__� <br /> DETERIV�1?�tING PLItM[T FEES <br /> ❑ SAC Cl�arge(2016 Rate=�2,.385.00) � <br /> tSAC Charbe iriust accompany all sewer permit�applications unless prepaid) <br /> (Orono City Staffi can determine iPapplicabie) <br /> (If not pre�>aid,a seH�er connection permit will not be issued) <br /> ❑Se�vcr Connection/Disconnect/Repair(��OAO/1'er Stub) � <br /> Pipe siz_e inches;materiai Schd 40 air tested; c�st iron <br /> S o0 <br /> �1'ater Cc���necti�rn/I)isconnect/Repair(550.00/Per Stub) $_ � ___"`-_ <br /> Pipe sve_(.�,. _ inches:n�aterial D��° Schd 40 air tested: copper <br /> ❑ Water availa�bility For Future Hook-lip Yo li'ater($�0.00) $__ <br /> i <br /> �'1�:�ter.Availabilitv Explanation: <br /> � Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected b��the Public VJorks Departmcnt. <br /> Required Before Water Connection Pcrmit is Issued: <br /> I. lssue!k'ater h�ieCcr& Horn Permit <br /> ?. ,4ny ,�dditional Connection Fees F'aid(IfApplicable) <br /> Issuc\'�'ater('�nnection PermiC: <br /> 1. Collect Permit Fee&tssue�'�%ater ConnecCion Permit <br /> � . vo <br /> O '"' <br /> 1. S[16"1'OTA1.,of Pennit Requested: � <br /> Z. STA'I'E SURCHARGE $ ___I.00 <br /> 3. POST,'�GE&HANDL�[NG Ivnly c�n iviail-In ,�pplications) $— ---„��`^' --- b� <br /> �4. TOT,aL {'Ef211�11T FEE(Add L,ines 1-3 Abovel � S � ✓ � <br /> ADDITIONAI� iNF�ORMATION —WA"TER METERS <br /> ■ WATER;1IETERS must be picked up and paid for at Orono Cit� Hall,these arc on a scparate permit. <br /> ■ WATER �ti1ETERS must be set and se�led b� O�•ono 1Vater Depxrtrnenf (952) 249-a600, upon <br /> completion of ineter installation. <br /> The undersigned hereb� applies to t}�e City of�rono for issuance ot� Utility Permit, agrees to do <br /> all ���oek in striet accorclance with the orclinances of the City and the regulations of the State of <br /> Minnesota.and ce��titics that all statements made on this application are,tr�ie and correct. <br /> �``' `�-`�� Zo l <br /> npplicant: .�-e--,�--�-�U-''-'e.,Q''a"Y- _ _ _..._ Date: _ _--� <br />