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+ � 'a�� _x �F`�`�'� �.t, ,�;s� �.,r <br /> ❑SAC Charge(2015 Rate=$2,485.00) $ <br /> (5AC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepafd,a sewer connection permit wili not be issned) <br /> �Sewer Connection/Disconnect!Repair($50.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> [�Water Connection/Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water{550.00) $ <br /> Water Availabilitv Eaulanation: <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 Pernut 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 Pernut Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ <br /> ADDITIONAL INFORMATION—WATER METERS <br /> • WATER METER5 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 instaRation. <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 aze,true and correct. <br /> ` Date:1 -\� - 1 � <br /> Applicant: a�, �.,. ' ,o <br />