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r . <br /> fr` <br /> 1, �:'47DETERMINING'PERM1T G ' ' , ••,.3.i:. <br /> ❑SAC Charge(2016 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 /> Seweonnec ' /Disconnect/Repair($50.00/Per Stub) $ 56, (50Pipe size inches;material Schd 40 air tested; cast iron <br /> IlkWater nnectio Disconnect/Repair($50.00/Per Stub) $ ,`�- -b,z5z) <br /> Pipe siz 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 /> I. Issue Water Meter& Horn Permit <br /> 2. Any Additional Connection Fees Paid(If Applicable) <br /> Issue Water Connection Permit: <br /> I. Collect Permit Fee& Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ /On , Q <br /> 2. STATE SURCHARGE $ 1.00 <br /> 3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 103_6-6 <br /> ADDITIONAL INFORMATION—WATER METERS <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: it,r,,(_(ii-d- Date: I '3 " <br />