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gv iv,�.r� e 0 c—o '13 C !3 ,O G /4--re, <br /> vvkDv-eo 433e.-r ems,,J (3( 9 6 S 4 <br /> ❑SAC Charge(2011 Rate=$2,230.00) $ <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($50.00/Per Stub) $ <br /> Pipe size 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; \K 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 /> NAG C RUAT N`-"WATER,i ce <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 made on,thiS application are;true and correct. <br /> Applicant: Date: t's-D 3.1 <br />