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DETERMINING PERMIT FEES <br /> ❑ SAC Charge(2013 Rate=$2,435.00) $ <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 Connect' Disconnect/ epair($50.00/Per Stub) $ <br /> Pipe size +nches; matena Schd 40 air tested; cast iron <br /> �ater Connec istr/�Disconnect epair($50.00/Per Stub) $ <br /> Pipe size �nches; 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: $ ��� �' <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ —�-98 <br /> 4. TOTAL PERMIT FEE(Add Lines I-3 Above) $ � � � �Z—` <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 ineter 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 tlle ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies tl at all statements made on this application are, true and correct. <br /> (M�' _ �.s-13 <br /> Applicant: Date: �1 <br />