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. . � . `� <br /> . C�.��� � 1 <br /> � \ <br /> L/ � <br /> ,��"��5�'����'�������'�"�+"�, � � <br /> �SAC Charge(2007 Rate=$1,675.00) $ <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 /> �Sewer Connection/Disconnect/Repair($35.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; 0 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 Permit Requested: $ , <br /> 2. STATE SURCHARGE $ .50 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMTT FEE(Add Lines 1-3 Above) $ <br /> ADDITIONAL INFQRMATION-'�VA'TE�Z IYIE`i'ERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a segarate nermit. <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 /> a11 work in strict accordance with the ordinances of the City and the regularions of the State of <br /> Minnesota,and certifies that all statements made on this application are,true and correct. <br /> Applicant: � Date: ��� �� <br /> °Reset Fvrm t = <br /> � , <br />