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12/07 2009 10:15 FAX C�002/002 <br /> :..: � <br /> ......,��;;:; �;;�; ;,����.:�i� <br /> ..::;.�:::.: � ,;,,� i� ,. . �. ;.�;. . �r;,,. •.:. �:,: „ <br /> ...�,...,:� .,a.�i t -.<, ini :i.i i s.�u : ` i i I; i Pi� �'ic.': .ir,�r��ii. <br /> � ,. . <br /> , <br /> . <br /> . , 'p�]��� [7� <br /> .,.., . ..� _... . .a���t�a��! t � , .'�� `,�i';��174;Lx:[ i"l�li� .I���._ 7�i��� '.o.�l�:l��isi <br /> '��.Il ,ai, <br /> ❑ SAC Charge(2009 Rate=�2,000.00) g <br /> ,(SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can detarmine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> I wer Connection/Disconnect/Repair($50.00/Per Stub) $ � � <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑'Water Connection/Disconnect/Repair(550.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> I <br /> ❑ ater Availability For Future Hook-Up to Water(550.00) $ <br /> Water Availabjlitv Exulanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Reauired Betore Water Connection Permit is Issued: <br /> � ]. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> L�sue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. UBTOTAL of Permit Reguested: $ � . � <br /> 2. ATE SURCHARGE $ ,50 <br /> 3. OSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. OTAL PERMTT FEE(Add Lines 1-3 Above) � ,� . ,� <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATE METERS must be picked up and paid for at Orono Ciry Hall,these are on a separatepermit. <br /> ■ WATE METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> complet n of ineter installation. <br /> The undersi ned here pplie o the City of Orono for issuance of a Utility Permit,agrees to do <br /> alI work in trict o ance ith the ordinances of the City and the regulations of the State of <br /> Minnesota, d i e a statements made on this application are, true and correct. <br /> Applicant: Date: � 7 o y <br />