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, <br /> 'i�a?���icM ,�I,��5'''z'� t u d'P �1 tf�$ 5.�i c � E` �+ 4 �+�p�,r : �M� k�s ar 'F � r r3i1�� y, <br /> .�'t'':�a r ,�,�� ,i f-. xi �lt' 13d�{`+y��������ti'i�.���-/F+�,?' �„�� � .�:r�r - � .��, } <br /> .�.,r �5��2 I t <br /> ❑SAC Charge(2005 Rate=$1,550.00) $ <br /> (SAC Charge must accompany all sewer pernut applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If not prepaid,a sewer connection permit will not 6e issued) <br /> �wer Connectio isco ct/Repair($35.00/Per Stub) $ <br /> Pipe size inches,material Schd 40 air tested; cast iron <br /> ❑Water Connection/Disconnect/Repair($35.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> 1. SUBTOTAL of Pemrit Requested: $ <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ;ADDITIONAL INFO�IVIATION—WATER NffMETERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate permit. <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 /> Applicant: Date: � v �� <br />