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, <br /> ❑SAC C6arge(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 coanection permit will not be issued) <br /> 5ewer Connection/Disconnect/Repair($50.00/Per Stub) $ �� � � <br /> Pipe size inches;materiai Schd 40 air tested; cast iron <br /> ❑Water Counection/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(550.00) $ <br /> Water Availabilitv Explanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> This line wiil 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 /> I. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SLJBTOTAL of Permit Requested: $ ���./ J <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLMG(On(y on Mail-1n Applications) $ 2.00 <br /> c' �= <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S� "`� <br /> ADDITTONAL INFORMATIOTI-WATER METERS <br /> ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a se�arate permit. <br /> ■ WATER METERS must be sct and sealed by Orono Water Department (952) 249-4600, upon <br /> completion of ineter 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 /> �., I <br /> � <br /> Appticant: , � � n Date: � �� <br /> . <br /> I <br /> l <br /> \ <br />