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� j <br /> ♦ <br /> � � �L�I�'�1LL�.�Y�V �JJ�1 1�LYV . . . . . . ., . <br /> ❑ 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/Disconnect/Repair($50.00/Per Stu�i) S <br /> Pipe size inches;material Schd 40 air tested; cast iron <br /> �� <br /> '�Water Conr�ection/Disconnect/Repair($50.00/Per Stub) $ � ����� � <br /> Pipe size��'inches;material�u 5�" Schd 40 air tested; copper <br /> ❑ Water Availability For Future Hook-Up to Water($50.00) $ <br /> Water Availabilitv Exnlanation: <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 VJater Meter&Horn Pernut <br /> 2. Any Addirional Connection Fees Paid(If Applicable) <br /> Issue Water Connecrion Permit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: � <br /> 2. STATE SURCHARGE $ 1.00 <br /> . 3. POSTAGE&HANDLING(Only on Mail-In Applicarions) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ADDITIONAL INFORMATION—VdATER 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 o!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 ifies that all statements made on this application are,true and correct. <br /> v� � <br /> t �(J � <br /> Applicant: <br /> � - Date: � <br />