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e � Ye"`a'_ VAMVO! <br /> �4+xgn.*, <br /> g <br /> I 53�, � � S °' ,*�: "'' '�'kd fir.. <br /> 0 SAC Charge(2016 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 connection permit will not be issued) <br /> Sewer Connectio isconnect Repair($50.00/Per Stub) $ <br /> / Pipe size inc e.. - is Schd 40 air tested: cast iron <br /> ..WaterConnectioepair($5i.ilva+,— <br /> Pipe size •" . chd 40 air tested; copper <br /> ❑Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availability Explanation: <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 /> Issue Water Connection Permit: <br /> I. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ /2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) <br /> Dt) <br /> ADDITIONAL INFORMATION-WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. <br /> • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of meter 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 •'e on this application are,true and correct. <br /> lJI <br /> IApplicant: . Date: (1,: g 17 <br />