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, <br /> D�'TERIU[Il��P�RMIT FEES � <br /> ❑ SAC Charge(2015 Rate=52,485.00) $ <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 Connectio /Disconnect epair($50.00/Per Stuti) $ ��` • �� <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> ❑ Water Connection Disconnect •Repair($50.40/Per Stub) $ ��� � <br /> Pipe size inches;ma enal Schd 40 air tested; copper <br /> ❑ Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Eanlaaation: <br /> Contractor installed line to inside of house for future hook-up. <br /> T'his line will be inspected by the Public Works Department. <br /> RecLuired Before Water Connection Permit is Issued: <br /> 1. Issue VJater Meter&Hom Permit <br /> 2, Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Coilect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Pernut Requested: $ L�� � <br /> 2. STATE SURCHARGE $ ].00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �V�S- '� <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 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: Date: ��1�� � ���G�� <br />