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_ . <br /> a <br /> �---___—_-__ D�TE���vrnrc�F�R�IT r-��� <br /> ❑SAC Charge(2015 Rate=$2,485,pU) $ <br /> (SAC Charge must accoin�any all sewer permit app[ications unless prepaid) <br /> (Orono City Staf�can�eYerrnine if��plicabl�) <br /> (If not prepaid,a sewer connection permit will not be issued) <br /> �] 5ewer Connection/Disconnect i Repair(�SO.OU/Per Stub) $ 5� �'— <br /> �� Pipe size �f inches;material X Schd 40 air tested: cast ir�n <br /> ❑Water Connection i Disconnect J Repair($50.00!Per Stub3 $ W��� ,/�D�'l�U�� <br /> Aipe size__inches;material__Schd 40 air testerl; copper <br /> ❑Water Availability For Future Hook-Up to Water(�SO.UQ} $ <br /> WaEer Availability Exulanation: <br /> Contr�ctor insialled line Eo inside of house for future hoc�k-up. <br /> This Iine wiil be inspected by the Pubtic Works Department. <br /> Required Before VlWater Connection Perrnit is Issued: <br /> I. issue VGater Meter&Harn Pennit <br /> 2. Any Additianal Connection Fees Paid(Tf A�piicable) <br /> Issue 4Vater Connection Permit: <br /> 1. Co{lect Permit Fee&Issue Watcr C`onnection Permit <br /> Od <br /> l. SUBTOTAL of Pennit Requested: $ S� ` <br /> 2. STATE SURCHARGE $ I.00 <br /> 3. POSTAGE&HANDLiNG(Oniy on Mai!-Tn Applications) $ 2.00 <br /> L, -� (�� <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ -� `? "-" <br /> � ADDiTIONAL INFOR�iATIUN —WATER NI.�..TEfcS � <br /> ■ WATER METERS must be picked up and paid for at Orono City Eiall,these are on a se�arate permit. <br /> ■ WATER i�1ETERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of ineter installation. <br /> The undersigned hereby appiies to the City of(�rono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordance with the ordinar�ces of the City and the regulations of the State of <br /> Minnesota, �id certifies ttiat �11 statements made on this apptication are,true and correct. <br /> r------ - <br /> Applicant !�1,� '','_._.� -�i ' Date: �Z- 1 S- 1 � <br />