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�-_ � � ______�-7I:'t�}�;IZ,i��tlN1N(► i'i_ftN11"f i;I-�ES _ �_� <br /> ❑ SAC Charge(2015 Rate=$2,485.00) $ <br /> (SAC Charge inust 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 Connection/Disconnect/Repair($50.00/Per Stab) � <br /> Pipe size__inches;tnaterial Schd 40 air tested; cast iron <br /> � Water Conn'gf tion J Disconnec epair($ .00/Per Stub) $ v�� _ <br /> Pipe size!%� inches;mater �d 40 air tested:____ copper <br /> ❑Water Availability For Fut�ire Hook-Up to 1�ater(�Sa.00) $ <br /> '� Water Availabilitv Expianation: <br /> Contractor installed line to inside of house for f'uture ho�k-up. <br /> This line wi;l be inspected by the Public Works Uepanment. <br /> Required Beforc Water Connection Permit is lssued: <br /> l. Issue Water Meter&Iiorn Permit <br /> 2. Any Additional Connection Fe�s Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Pei-mit Fee&Issue Water Connection Permit <br /> 1. SIIBTOTAL of Permit Requested: $ ��,bv <br /> 2. STATE SURCI-[ARGE $ 1.00 <br /> 3. POSTAGE& HANDLING(Only on M3il-In Applications) $_ _2.00 <br /> �. TOTAL, FFR�117'FEE(�dd Liites 1-3 Aoove) $ c�/,�� <br /> � ADDIT!(?NAL INFORMA"TI(?N—WATER METERS _� <br /> ■ WATER ME'f'ERS must be picked up and paid far at Orono City 1-�a11,1hese are on a sepc�rate permit. <br /> � WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of ineter installation. <br /> 1'he undersi�;ned 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 /> Applic __ Date: �� ��!/ <br /> — — — �-- <br /> �� <br />