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� � y <br /> ����� '��� �° � ����� �� �� ~� ��� DETERMINING PERMIT FEES � � � � � � ' <br /> � �. �. <br /> ❑ SAC Charge(2012 Rate=$2,365.00) $ <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 Connection/Disconnect/Repair($50.00/Per Stub) $ ��� � � <br /> Pipe size `�„inches;matenal�'`�!�Schd 40 air tested; cast iron <br /> �] Water Connec�ion/Disconnect/Repair($50.00/Per Stub) $ �� � � <br /> Pipe size L_mches;materia��hd 40 air tested; copper <br /> i� <br /> ❑ Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Exalanation: <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 Pernut is Issued: <br /> 1. Issue Water Meter&Horn Pernlit <br /> 2. Any Addirional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Pernut 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) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ lQ�. �� <br /> ADDITIONAL 1NFORMATION—WATER METERS ' <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut. <br /> ■ WATER METERS must be set and sealed by Orono VVater 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 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 /> � <br /> � Applicant: � �Z'� Date: ����(�� �� <br />