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` <br /> ; M �i�'�� ��+ t.� k i+ gm � r- a� �. _ '�- �,�r°� ' <br /> � `�5^� ���e;�_ � ��, °�:r4� ��`� d�- " *���;�Y, �� �k.;�Po�a� i,a=�. <br /> 9r����v��Q �h �s9z g/�9/�`� <br /> ❑SAC Charge(2005 Rate=$1,450.00) $ <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 Connection/Disconnect/Re air($35.00/Per Stub) $ J�, � <br /> Pipe size�inches;material�Schd 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repair($35.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> r,� O�� <br /> 1. SUBTOTAL of Permit Requested: $ �.J. <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> �� �a <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ .�� • <br /> ADDITI4NAL 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 /> completioa 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 /> Applicant: Date: ;�'1 ��'����0 <br /> P��'�k .' t .�i:' � ^ }.{�v <br /> � �� iI <br /> r <br /> . 71(��, I . .. i <br />