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0411412015 10:13 SAX) P.0021002 <br /> ❑SAC Charge(2015 Rate-S2,4W.00) $ <br /> (SAC Charge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (};f not prepaid,a sewer connection permit will not be Issued) <br /> Sewer Connection/Disconnect/Repair($50.00/Por Stub) S S o r D z_ <br /> Pipe size q inches;material 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 Availability Exe nation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line will be inspected by the public Works Department. <br /> Reaulred 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 ecti n Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of permit Requested: $ e d� <br /> 2. STATE SURCHARGE <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) <br /> 4. TOTAL PERMIT FEE(Add Lines 1.3 Above) <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a semaratc 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 thV statements made on this application are,true and correct. <br /> Applicant: Date: �� — <br />