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. � •� <br /> DETERMINING PERMIT FEES <br /> ❑ SAC Charge(2013 Rate=$2,435.00) $ <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can detertnine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> �Sewer Connection Disconnect/ pair($50.00/Per Stub) $ �../� , 0� <br /> Pipe size inc�es;material Schd 40 air tested; cast iron <br /> ❑ Water ConnecNon/Disconnect/Repair($50.00/Per Stub) x <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑ Water A��ailability For Future Hook-Up to Water($,50.00) $ <br /> Water Availabilitv Exnlanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Required Before Water Connection Pennit is Issued: <br /> l. Issue Water Meter&Horn Pennit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Pennit Fee&Issue Water Connection Permit <br /> l. SUBTOTAL ofPennit Requested_ � �0, � � <br /> 2. STATE SURCHARGE � 5.00 <br /> 3. YOSTAGE&HANDLING(Only on Mail-In Applications) $ �0 <br /> 4. TOTAL PERMIT FEE (Add I,ines 1-3 Above) $ S�� � <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER�'IETERS must be picked up and paid for at Orono City Hall,tl�ese are un a separate permit. <br /> ■ ��'ATER METERS must be set anci sealed by Orono Water Department (9S2) 249-4600, upon <br /> compleNou 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 /> Applicaut: !/ Date: j ' �' �� <br /> `.. <br />