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tY Y1� �+ +;: ? 9! � � �,'�t. <br /> moa °' an�x <br /> ❑ SAC Charge(2007 Rate=$1,675.00) $ <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 /> 0 Sewer Connection/Disconnect/Repair ($35.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repair ($35.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ADDITIONAL INFORMATION—WAFER 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 application are,true and correct. <br /> Applicant: Date: <br />