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:�' ��� f� _: ����.�� ��' DETERMINING PERMIT FEES '' ���n°� `k-J <br /> ���, <br /> ❑ SAC Charge(2009 Rate=$2,000.00) $ <br /> (SAC Charge must accompany all sewer pernut applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If oot 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 /> � <br /> [��Vater Connection/Disconnect/Repair($50.00/Per Stub) $ ,`7 L- - <br /> Pipe size inches; material Schd 40 air tested; copper <br /> ❑ Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Exalanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works D,epartment. <br /> Required Before Water Connection Pernut is Issued: <br /> 1. Issue Water Meter&Horn Pernut <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Perniit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ �(�' (.� _ <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ �_ <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ <br /> ADDITIONAL INFORMATION—WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a se ap rate pernut. <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 /> � �� <br /> Applicant: , 'Vl.�-�� ; ������;�-t�� <br /> Date: ��"�.-( -�� � <br /> // <br />