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' � <br /> ❑SAC Charge(2011 Rate=$2,Zso.00> $ aa3D.DC� �d �y �.Ny.� <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) �'1d�'� <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> �Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ ��•D � <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($50.00) $ <br /> Water Availabilitv Ezplanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> RecLnired Before Water Connection Pemrit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connecrion Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ 50. � D <br /> ,� <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLIN�i(Only on Mail-In Applications) $ .2tQ6' <br /> , • 4. TpTAL PERMIT FEE(Add Lines 1-3 Above) $ �, �. J'r��� <br /> t � � /[ �S <br /> �s� �3��; �����������[���F ���W.}�� ��� # 'i�:"�. <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 /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Pernut, 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 certi�s that all statemerits m`�ie on this application are,true and correct. <br /> ! . <br /> Applicant: q �C �-Date: ��(;'�� aOI� <br /> :�---- , <br /> /% (iYl,e✓I�Ca v� �.L>C. <br /> l <br /> �.�"•� <br /> /i <br /> ... � <br />