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� <br /> DE'TER�III�tING PERMIT FEE� � <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 apnlicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> �SP pe s Zennectio'p�scmater al �e�a'Schd 40 aP te Sedb) cast ir n � �, Z <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 Availabilitv 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 /> l. 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) $ .'1�0 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ �„J, �� <br /> � ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono Ciry 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 witll tl�e 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 /> I � I 7 <br /> Applicant: V VC� Date: UL� / Z`� � � � <br />