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f <br /> DET RMW,IN P S <br /> SAC Charge(2013 Rate=$2,435.00) $ <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 /> � SewerConnec ion/Disconnect/Repair($50.00/Per Stub) $ o O--O <br /> Pipe size inches;materialip0C., 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 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 /> 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) $ <br /> ADDITIONALINFORMATION-WATER METERS <br /> ■ W TER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. <br /> ■ W TER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon <br /> co pletion of meter installation. <br /> i <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agrees to do <br /> allw rk in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minn sota,and certifies that all statements made on this application are,true and correct. <br /> Appli anItl(3a� Date: 5//V/3 <br />