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� <br /> . <br /> r <br /> r <br /> F ���� F .nI' S <br /> ❑SAC Charge(2015 Rate=$2,485.00) $ <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 /> S`'�. � v <br /> �Sewer Connection/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 /> �'�v. a c� <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Ezalanation: <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 Permit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional 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 /> �n�iTia�v�,nvFo�T�a�v-w���r���s <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 hereb plies to City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict ac rd ce wit ordi e i the regulations of the State of <br /> Minnesota,and ce ifi that al ta ments mad n this application are,true and correct. <br /> Applicant: L- Date: <br /> � - z � - /� <br />