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. <br /> DE"I'�RMINING PERMIT rEES <br /> ❑ SAC Charge(201.5 Rate=$2,485AOj S <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 /> :-v <br /> �-` ��.� . <br /> �Sewer Connection�sconnech/Repair($50.00/Per Stub) � <br /> Pipe size inches;matenal 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 F'uture Hook-Up to Water($50.00) $ <br /> Water Avaitabilitv Explanatinn: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Pubiic Wocks 17eparement. <br /> Rec{uired Before Water Connection Permit is Issued: <br /> I. Issue Water Meter&Narn Permit <br /> 2. Any Additional Connection Fees Paid(1f Applicable) <br /> Issue Water Connection Permit: <br /> l. Collect Permit F�ee&lssue Water Connection Pennit <br /> 1. SUBTOTAL of Permit Kequested: $ <br /> 2. STATF SURC�iARGE $ 5.00 <br /> 3. PO5TAGE& HANDLING(Oniy on Mai{-In Applications) $ 2.U0 <br /> Ou <br /> 4. TOTAL PERMIT FEE(Add Lines 1-:i Above) $ � 7 — <br /> � �� ADDITIONAL INFURMATION--WATER JVIETERS � � <br /> ■ WA"TER METERS must be picked up and paid for at Orono City Hall,these are on a senarate permit. <br /> • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of ineter instailation. <br /> The une�ersigned l�ereby applies to the City of Orono for issuance of a Utility Perrnit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Sta#e of <br /> MinnesoCa,and c rtifies th 1 statements made on this application are,true and correct. <br /> i <br /> Applicant: '�� Date: � "� '"IS <br /> V <br />