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• <br /> / . <br /> DETERMINING PERMIT FEES <br /> pd �1c' 2 3-4 -c� <br /> 1:1 SAC Charge(2015 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 Connection Cha e-City of Long Lake(Pass Through Fee)$ <br /> i12� OU <br /> (2015 Rate=$1,9 .00) , , goo 00 ? , - I` ,^ , r L� <br /> ❑ Water Connection Charge-City of Long�Lake t(Pa�ss Through Fee)$ <br /> (2015 Rate-$1,900.00) <br /> E Water Connection Opt-Out-(Please Initial) <br /> I am choosing not to hook-up to water at this time. <br /> El Water Availability- (Please Initial) <br /> I am choosing not to hook-up to water at this time. I have chosen to <br /> have my contractor make it water available for future hook-up. <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 /> inC <br /> TOTAL PERMIT FEE(Add Fees Listed Above) $ J ` K Co <br /> ADDITIONAL INFORMATION-WA 1'bR METERS <br /> • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. <br /> Typically the contractor will pick-up and pay for this 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 th. j statements made on this application are,true and correct. <br /> GdN1,Z4c--rat- "X,e/re <br /> Owner: / Date: <br />