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To: 9522494616 From: Dispatch 12-08-17 3:20pm p. 3 of 4 <br /> ❑SAC Charge(2016 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 /> Ff-Sewer Connection/Disconne Repa' $50.00/Per.Stub) $ <br /> ..... ...... <br /> Pipe size 14 inches;material ',ir Schd 40 air tested; ./(/() .cast iron <br /> 0 Water Connection%Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> 0 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 beinspected 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: $ <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 • <br /> 4. TOTAL PERMIT FEE(Add Lines 1;3 Above) <br /> ADDITIONAL INFORMATION-.WATER METERS <br /> WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. <br /> WATER METERS must be set 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 applicationare,true and correct. <br /> Applicant: _• <br /> , �� ' Date: 5S 7 <br /> M <br /> 763- 336-71 <br />