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� <br /> , �r " DETERMININGr PER:MZ�':' EES <br /> x, <br /> ;�SAC Charge(2009 Rate=�9A�A0) �Z � �=�-=' $ � , ((J c� <br /> � �(SAC Charge must accompany all sewer pernut applications unless prep ia d <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> S�"S � <br /> '`�Sewer Connection Ch e—City of Wayzata(Pass Through Fee) $ � <br /> (2009 Rate=$�35:$9�;S� <br /> �'ater Connection Cha " —City of Wayzata(Pass Through Fee) $ �� � � '" <br /> (2009 Rate-$�;9�:@0�?�"L�j <br /> ) <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 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 Connecrion Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> TOTAL PERMIT FEE(Add Fees Listed Above) $ � ��� <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate 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 he applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all wark in strict ccq7-dance with the ordinances of the City and the regulations of the State of <br /> Minnesota, a �,�ies that all statements made on this application are, true and correct. <br /> Owner: Date: 7��S (� J <br /> � <br />