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w � <br /> �------`—. DE'T'ERMINIT�IG I'�RMIT FEES <br /> ❑SAC Charge(2015 Rate=52,485.00) � <br /> (SAC Char�e must accompany all sewer permit applications unless prepaid} <br /> (Orono City Staff can detennine if applicable) <br /> (tf nut prepaid,a sewer connection permit wilt naf be issued) <br /> �Server Connection/Disconnect/Repair(�SQ.00/Fer Stub) � � �` � �-�'' <br /> Pipe si•r.e_^ inches;material��-'�' Schd 40 air•tested;�_casi iron <br /> �,� 1Vater Connection l Disconnect/Repair($50.00/Per Stub) � <br /> Pipe size inches;material��Schd 40 air tested;_____�oPper � � <br /> ❑Water Availabiiity For Futnre Hooic-Up to Water('$50.00) $ <br /> `�'ater Availabilitv Exnlanation• <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Departmeot. <br /> Rec�uired Before Water('onnection Permit is Issued: <br /> ` 1. Issue Water Meter& Horn Permit <br /> 2. Any Additional Connection Fees Paid(IfApplicable) <br /> lssue Water Con��ection Permit: <br /> �. Colleet Rermit Fee&Tssue Water Gonnection Permit <br /> l. SUBTOTAL of Permir Requested: � ���`j �`;� <br /> 2. STATL SURCHARGE �_ 5 Q� � <br /> 3. POST.qGE&F�tAI�rDL.1RG(On1y�n Vlaii-In Applications) $_ -2,04- <br /> 4. TOTAL PEF211[T FEE(�dd Lines 1-3 �bove) � �j� `';�� <br /> , <br /> ADDITIONAL INFORMATION— WATER METERS <br /> ` W.ATER 1�IETERS must be picked up and paid for at Orotao City r1a11,these are on a separatepermit. <br /> � WATER �IETERS must be set and seated by Orano Water Department {9�2) 249-4600, upon <br /> com��letian of ineter installation. <br /> The undersigned hereby applies to the City oi'Orono for issuance ofa Lltility Yermit, agre�s to do <br /> ail work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota,and certit7es that all statements made on this application are,true and correct. <br /> /' j� ' �- <br /> Applicant: U `� ��, Date: � ��1 {�� <br /> , <br /> E `�. <br />