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, <br /> � <br /> ''�` DETERMINING PERMIT:FEES : - <br /> ❑ SAC Charge(2005 Rate=$1,550.00) $ <br /> (SAC Charge must accompany all sewer pernut 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 Connection/Disconnect/Repair($35.00/Per Stub) $ <br /> Pipe size�inches;material Q j�(�chd 40 air tested; cast iron <br /> T - <br /> �V4'ater Connection/Disconnect/Repair($35.00/Per Stub) $ <br /> Pipe size�_inches;material Schd 40 air tested; copper <br /> ` �/,V``� <br /> l. SUBTOTAL of Peniut Requested: $ <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add L'uies 1-3 Above) � <br /> ADDITIONAL INFORMATION-WATER iv1"ETERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut. <br /> ■ VVATER 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 Orono for issuance of a Utility Pennit; agrees to do <br /> al] work in sn-ict 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 con�ect. <br /> . <br /> Applicant: Date: _9 f� 0 �� <br /> � <br />