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i <br /> ❑SAC Ch�rge(2012 Rate=$2,365.00} � <br /> (SAC Charge must accampany all sewer penriit applications cuiless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (Tf not prepaid,a sewer connection permit will not be issued) <br /> Sewer Connection/Disconnect/Repair($SO,UO/Per Stub} � �' v� <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑R's►ter ConnecEion/Disconnect i Repair(SS0.40/Per Stub} $ <br /> Pipa size inches;material Schd 40 air tested; copper <br /> ❑Water Availability Fo'r Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Esnlauation: <br /> Contractor installed line to inside of hovse for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Rectuired Before Water Connection Pernn.it is Issued: <br /> . 1. Issue Water Meter&Hom Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable} ° <br /> Issue Water ConnecYion Permit; I , <br /> i. Collect Permit Fee&Issue Water Connection Pernut <br /> 1, SUI3TOTAL ofPermit Requested: $ <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-3u Applications) $ �—�(�q-- <br /> 4. 1'OTAL PERMIT FEE(Add Lines 1-3 Above) $ �j• � <br /> - _., <br /> . . <br /> . �, f.a�? i� s�;J �"`dPit:��� ��i , y �s'r� �x F�t ; i a YNl i� � p� � {�� i� ...t ��.(��. ���,t <br /> JW`l�� � <br /> ,. <br /> . �;�,'� ,.,,., �),;,IOI�' ,�'M,A:�'�4�_�!W R N.�,4. �� � � � <br /> • ,_�... , . <br /> .�� <br /> • WATER METERS must be picked up and paid for at Orouo City HalI,these Tre on a separate ormit. <br /> ' WATER METERS must be set aud scaled by Orono Wuter Departu�eut (452) 249-4600, upon <br /> coznpletion o#meter installation, <br /> The undersigned hereby applies to the City of Orono for zssuance of a Utility Permit,agrees to do <br /> aIl �vork in strict accordance with the ordinanccs of the City and the regulations of the State o£ <br /> Minnesota,and certifies that all statements made on this application are,true and correct. <br /> � <br /> �' ���-� <br /> ��y + r' c� <br /> Applicant: !�- �.�.;/� Date: �` //��� <br />