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� ,01�7-'14 15;23 F�OM- T-791 P002/002 F-816 <br /> Q SAC Char�e(2014 Itate=SZ,4$5.00) S <br /> (SAC Char�e muat accompany all sewer permit applications unleas prepsid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sew�er connect5on permit will not be issued) <br /> r <br /> �Sewer Cannection/Disconnect/Repair(550.00/Per Stub) S aD <br /> Pipe sizc inchcs;matcrial Schd 40 sir tcsCcd; cast iron <br /> b!'�"�•.r.r <br /> ❑Wate�Connection/Disconbect/Repair(550.00/Per SCub) $ <br /> Pipe eize inches;material Schd 40 air tested; copper <br /> []'1�Vater Avai�sbi�itty k'o�r b'uture Hook-Up to Water($50.00) $ <br /> � '1'Vater Availabilitv Fsolanation: <br /> Contractor installed line ta inside of housc for futurc hook-up. <br /> This 1'1ue will be i�lspected by tbc Public Works Dcparhncnt. <br /> Rec�uired Be�91'&_ ater(:nnnection Pertnit is Issued: <br /> � 1. �esue Water Meter&Horn Penni,t <br /> • 2. Any Additional Connecfian Fees Paid(If Applicable) � <br /> Issue'Water Connec'o it: <br /> 1. Collect Permit Fee&Issue Water Conuection Permit <br /> . 1. S�TO�'AI.of Pexmit R,equestcd: $ <br /> 2. STATB S�tCHARGE $. 5,00 <br /> 3. pOSTA(�B&HANDI.ING(Only on Mail-In Applications) $ ' 2.00 <br /> 4. TOraY,p�1�T FEE(A.dd�.�n�s r-3 Abovc) : $ �7 � <br /> , o <br /> � WATER METERS must be picked up ar►d paid for at Orono City Hall,thcsc arc on s st�arate permit: <br /> • WA�R N�TERS mnst be aet and gealed by Orouo'1VVater Aepartment(952) Z49-4600, upon <br /> completion of�aueter installation. <br /> , , <br /> � The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agees to do <br /> all work in strict accardaz�ce with the ordinances af the City and the regulat�ons of the �tate pf <br /> Minnesqta,and eertifies that all statements rnada on this applieation are,true and cormct. <br /> Applicant• � ���+L� Date:����1� <br />