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1011512015 16:14 FinalGrade (FAK)952 492 5101 P.003/003 <br /> DETE" e U$* :! R (T FEES <br /> ❑SAC Charge(2014 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) L <br /> Sewer Conn coon/Disconnect/Repair($50.00/Per Stub) $ <br /> Pipe size inches;material �{ Schd 40 air tasted; 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 Explanations: <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: $t'• <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.0 to <br /> • <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) . $ <br /> ADDITIONAL INFORMATION—WATER METERS <br /> C' 95).0 - 19 -oe <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 st: t ents made on this application are,true and correct. • • <br /> D <br /> Applicant: �� , ! - J <br /> Date: 1�,//7 <br /> 4 . /e//Y.L" <br /> 44' xii/ <br />