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4 ' <br /> t> �. f�a� ,t..a°�t <br /> €�',� f"�� ', i � � s.� '�✓ `�S <br /> , - , <br /> . <br /> , . , <br /> � .k �, i ..3a�t�f���x <br /> ❑SAC C6arge(2015 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 conn�tion permit wili not be issued) <br /> �wer Connecti isconnect/ epair(550.0(1/Per Stub) $ �� . ��() <br /> Pipe size m , al Schd 40 air tested; cast iron <br /> �Water Connec ' Disconnect/ air($50.00/Per Stnb) $ ��� <br /> size � , enal Schd 40 air tested; copper �— <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Eanlanation: <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 Pernut <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> 1. CotIect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ ��- �� <br /> 2. STAT'E SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ –� <br /> 4. TOTAL PERMTT F'EE(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 separate permi� <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 Pernut,agrees to do <br /> a11 work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota,and ce ' es that all statements made n this application are,true and correct. <br /> Applicant: — Date: J���G1,� <br />