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1111812014 14:58 FinalGrade �FAX)952 492 5101 P.0031003 <br /> E. _ Paw pa <br /> ❑SAC Charge(2014 Rate=S2,485.00) $ <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 Connqqj t'io,n/Disconnect/Repair($50.00/Per Stub) $ `� ' <br /> Pipe size�inches;material-,K_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 Availability Explanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department, <br /> Required Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ 400 <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> TOTAL PERMIT FEE(Add Lines 1-3 Above) 0,C7 <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate p&rmit, <br /> ■ WATER METERS must be at and sealed by Orono Water Department(952)249-4600, upon <br /> completion of meter 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 certifies that all statements made on this application are,true and correct. <br /> Applicant Date ��/�� / <br />