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.r � <br /> ` DETERMINING PERMIT FEES <br /> ❑ SAC Charge(2014 Rate=$2,485.00) $ <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 /> --_._ ___._ — <br /> Se,,,�r C�o�nnectioq!-Disconnect/Repair($50.00/Per Stub) $ � �� � �) <br /> 'T�_�________.___ <br /> Pipe s�ze inches;material Schd 40 air tested; cast iron <br /> ��___, � �. �� <br /> �'Water Co/ nnection/ sconnect/Repair($50.00/Per Stub) $ � <br /> Pipe size-' mches;material Schd 40 air tested; copper <br /> ❑Water Availabilit�-For Future Hook-tip to Water($50.00) $ <br /> Water Availabiliri�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 Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ ����, ��� <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> , <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��. ���� <br /> , <br /> ADDITIONAL 1NFORMATION—WATER METERS <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 V�ater Department (952) 249-4600, upon <br /> completion of ineter installation. <br /> The undersigned hereby applies to the City of Orono for issuance of a Utiliry 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 /> � � `" f /�/' C - � �-' <br /> Applicant: �����C/ Date: � ' � � � <br />