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Jul 2616 01:11 p Metro Earthworks 763-428-2212 p,2 <br /> .. <br /> . ... . <br /> �,� _: � g . - - <br /> ... .. <br /> ,, , . , :- , <br /> g.y R� x� <br /> . .-_'.'� .:*'. .. �.:... . ..:-. . .e�:i': _. ..� ._ �... . _ .. ...... . ...�. . <br /> . <br /> � • � ; <br /> ❑SAC Charge(?A16 Rate=�2,485.00) � <br /> (SAC Charge raust accompany all sewer permit applications uniess prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer eonnection permit will aot be issued) <br /> �er Connection connect Repair(550.00/Per Stab) S <br /> Pipe size imches;matenal Schd 40 air tested; cast imn <br /> ❑Water Conneciion/Dlsconnect!Repair(SSO.00/Per Stub) $ <br /> Pipe size inches;matesial Schd 40 air testecl; eoppex <br /> ❑Water Availability For Future Hook Up to Water($SII.00) � <br /> Water Availabil[tv Eznlaaatioo: <br /> Contractor installed liQe to inside of house foc future hook-up. <br /> This line will be inspected by the Public Works Deparhnent. <br /> Reqw't�ed Be�a,�e Water Coimection Femut is Issaed: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Conneetion PermiG <br /> 1. Collect Permit Fee&Issue Water Connectian Petmit <br /> 1. SIJBTOTAI,of Permit Requested: $ <br /> 2. STATFs SURCHARGE $ i.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAI.PERMIT FEE(Add Lines l-3 Above) S <br /> .ADDITIOtVAL INFORMAT�ON—WATER METERS <br /> ■ VE'ATER�iETER5 musE be picked up a�d paid for at arona Ci�y HaII,these are on a seoazate permit. <br /> ■ WATER METERS must be set and sealed by Orono W�ter Department(952)249-4600, upen <br /> completion o!meter installatian. <br /> The undersigned hereby apglies to the City of Orono for issuance of a Utilify Pertnit,agrees to do <br /> all work in strict accordance with the ordinances of the City and the reguiations of the State of <br /> Minnesota,and certifies that all statements made on this application are,true and correc� <br /> Applicant• r' �.�' Date: � �� 7 <br />