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I . . <br /> � �������.� ` ��x <br /> .i�'� ..,L.�. ba '� ��+1�� . -��3 �.��.`� ��^tia ..«x � � 5�s<;,3.,;: <br /> ,X,� <br /> ❑SAC Charge(ZO1S Rate=52,4$5.04) S <br /> (SAC Charge rnust accampany ail sewer permit appiications unless prepaid) <br /> (Orona Gity Staff can detemune if applicable) <br /> (If c�ot prepaid,$sewer connection permit will not�re issued} <br /> �Sewer Connection/Disconnect/Repair($S�.001Per Stub) ' � <br /> ��� <br /> Pipe sixe in�hes;material Schd 40 air tested; cast iron <br /> Q�ater Connection/Disconnect/Repair{$50.00/Per Stub) $ �� <br /> i�tpe size inches;material Schd 40 air testeci; capper <br /> ❑Water Avai[�bility Far Future Ht�ok:Up to VVater{$50.40) $ <br /> V1'ater Availabilitv Exolanatioo: <br /> Contractar installed line to inside of house for future hook-up. <br /> This line will be inspected by the Pwb}ic Works Department. <br /> Reaurred Befirre Water Connection Permit is Issued: <br /> i. 'issue Water Meter 8c Hom Percnit <br /> 2. 'Any Additional Connection Fees Paid(IfApplicable) <br /> Issue W,atez Cannection Permit: <br /> 1. 'Collect Per�nit Fea&I.ssue Water Gonnection Permit <br /> 1. SUBTO'�Ai.of Permit Requested: � � <br /> �•�J'e <br /> 2. STAT'E S'URCHAR.GE $ 1.00 <br /> 3. POSTAGE&NANDLING(Only on Mail-In Applications) $ 2.OQ <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ADI7ITlt)I�T�.L £I�iFQRMATIUN-WATER METERS <br /> ■ WATER METERS must be picked up and paid for at thono City Hall,:these are on a se.parate peimit. <br /> ■ WATER METERS m�st be set and sealed by Urono Water Department(952) 249-4b00, upon <br /> completion af ineter i,nstalla#ion. <br /> The undersigned heTeby appties to the City of Orono for issuance of a Utility F'ermit,agrees ta do <br /> alt work in stric# aecordance with the ordinances of the City and the regulati.ons of the State af <br /> Minnesota,artd certifies that all statements made on this application are,true and carcect_ <br /> _ � � � <br /> Applrcant: Date: <br /> . ' . �7��-�����'��� <br /> �1���. ,� ��� � <br /> � .��..��-�. �� � �-G .._._._.,. . <br /> � <br />