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�. � <br /> � � ` f)n � �Z�� ��� ���_ 2 ��� ,�e � <br /> ikr.��v aF,, f� s`�,. ufr+�c;�"� yS���, � �������.�5 svt;d�A��Ji Y- ¢ �:+�mS. <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 applicable) <br /> (If not�prepaid,a sewer connectio� permit will not be issued) <br /> �Sewer Conn ction/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 fo Water($50.00) $ <br /> Water Availabilitv Explanation: <br /> Contractar installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Reauired 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 /> 1. SDBTOTAL ofPermit 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) $ <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 wark�i��s,t�'ict�,accor.danc� with�the�ordina�ces of.th�e City and the regulations of the State of <br /> Minnesota, and certifies that all statement a o this application are,true and correct. <br /> . <br /> / �_ <br /> Applicant: Date: � �� <br />