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1 <br /> / ► <br /> D�TF��.I�+C�P��tA�.i�`FE� <br /> ❑ SAC Charge(2a15 Rate=$2,485.00) $ <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 Coanection/Disconnect/Repair($50.00/Per Stuti) $ <br /> Pipe size inches;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 Ezulanstion: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Req,nired Before Water Connection Permit is Issued: <br /> l. Issue VJater Meter&Horn Permit <br /> 2. Any Addirional Connection Fees Paid(If Applicable) <br /> Issue Water Connecrion Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: � <br /> 2. STAT'E SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S <br /> ADDITIONAL INFORMATION-WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a se�arate 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 Oron or issuance of a Utility Permit, agrees to do <br /> all work in strict accordance with the ordinance of the City and the regulations of the State of <br /> Minnesota, and certifies that statements ma� on this application are,true and correct. <br /> /,,r� i / � <br /> Applicant: <br /> � Date: ` � ' � b " �� <br />