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! � <br /> ,: . <br /> >':a y �� :x ^�� 4 ''zi � ',1 �� 3- vs .2:.5 <br /> ^ „"" " .` .j � �. <br /> _�i.�. .x� - .�����.. .,k,�. .V, F'�t�,� �k� <br /> ❑SAC Charge(2013 Rate=$2,435.00) $ <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can dete ' e if applicable) <br /> (If not prepaid,a sewer connect� permit will not be issued) <br /> � �J Sewer Connecti /Disconnect epair($50.00/Per Stub) $ <br /> � " Pipe size inc ; al Schd 40 air tested, cast iron <br /> �Water Connection/Disconnect/Repair($50.00/Per Stub) $� <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Exalanation: <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 Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> lssue Water Connection Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ �� � <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �1 � <br /> � ,.: <br /> � ` �U�Q���`��:�'��� ;-�-�'�.T'��� :���+�" ,...�m� ` <br /> � ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate ermit. <br /> ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completioo of ineter installation. <br /> The undersigned hereby applies to the Cit�o�Orono for issuance of a Utility Permit, agrees to do <br /> all work:i� s�'`icY,accordanc� with't�ie•ordinances df.ttre City and the regulations of the Sta.te of <br /> Minnesota,and certifies that all statements made on this application are,true and correct. <br /> Applicant: Date: J�� / � �/� <br />