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� \�� ��*`� . � � E����J.����������.4���.J ;/ .'�g� yw `;� �..x-�: <br /> ❑ SAC Charge(2013 Rate=$2,43�.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 wilt not be issued) <br /> �Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size�inches; material�Schd 40 air tested; cast iron <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 Availabi(itv Explanation: <br /> Contractar installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Warks 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 /> l. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERI�ZIT 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 ineter installation. <br /> The undersigned hereby applies to the Citx of Orono for issuance of a Utility Permit, agrees to do <br /> all work,i� s,tt'ict,accor.danc� with'the�ardina�ces of.th•e City and the regulations of the State of <br /> Minnesota, aud certifies that all statements made on this application are,true and correct. <br /> � <br /> Applicant: Date: ��'�� W � <br />