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�SAC Charge(2011 Rate=$2,230.00) $ 0�4�3� •� � <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 Charge—City of Wayzata(Pass Through Fee) $ �75• V 0 <br /> (2011 Rate=$575.00) <br /> ❑Water Connection Charge—City of Wayzata(Pass Through Fee) $ <br /> (2011 Rate-$2,080.00) <br /> ❑ Water Connection Opt-Out—(Please Initial) <br /> I am choosing not to hook-up to water at this time. <br /> ❑ Water Availability— (Please Initial) <br /> I am choosing not to hook-up to water at this time. I have chosen to <br /> have my contractor make it water available for future hook-up. <br /> Water Availabilitv Explanation: <br /> Contractor instailed 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 Pernut is Issued: <br /> 1. Issue Water Meter&Hom Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Pernut <br /> � G <br /> TOTAL PERMIT FEE(Add Fees Listed Above) $ O�8�!• � � <br /> ADDITIONAL IIVFORMATION—'WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a sevarate pernut. <br /> Typically the contractor will pick-up and pay for this 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 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 /> c < I <br /> Owner: �I JC�yVIQSWP1h-�'Yl��(� Date: ' C , � �1 S <br />