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. � • �� <br /> � (^ • <br /> '' ,� �-��; ,� 1,° /�(/`�/Z _,-l/�i?f i�.//1�( ; �r .'e' .`r- �' .n <br /> _ .. <br /> ���; DETERMINIl�IG PERMIT FEES <br /> ❑ SAC Charge(2009 Rate=$2,000.00) $ UaO, d �/ <br /> (SAC Charge must accompany all sewer permit applications unless prepai <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) $ <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 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 Permit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connecrion Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Pernut <br /> 1. SUBTOTAL of Permit Requested: $ ���J� � Q <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ O�J�v�J��� <br /> ADDITIONAL 1NFORMATION—WATER METERS <br /> • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pemut. <br /> ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completioi�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 certif that all statements made on this application are, true and correct. <br /> Applicant: Date: // ��" <br />