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� <br /> ❑ SAC Charge(2012 Rate=$2,365.00) $ <br /> (SAC Charge must accompany all sewer permit applicarions unless prepaid) <br /> (Orono City Staff can deternrine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> � <br /> �ewer Conne tion/Disconnect/Repair($50.00/Per Stub) $ � <br /> Pipe size�inches;material�Schd 40 air tested; cast iron <br /> �ater Connection/Disconnect/Repair($50.00/Per Stub) $ <br /> �� <br />. Pipe size�inches;material Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Ezulanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Deparhnent. <br /> Required Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter&Horn Pernut <br /> 2. Any Addirional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ���• � <br /> ` ADD�`�'I4�tAL TNFORNIATIC,��T-WATER METEI�S`' <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 or 'nances of the City and the regulations of the State of <br /> Minnesota,and that all state s de n-this application are,true and correct. <br /> Applica • Date:c��[Z— I� <br />