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❑SAC Charge(2013 Rate=$2,435.00) $ <br /> (SAC Chazge must accompany all sewer permit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If oot prepaid,a sewer connection permit will not be issued) ` <br /> ❑Sewer Connecti Disco pair($50.00/Per Stub) $ J�� ��J <br /> Pipe size utches;material Schd 40 air tested; cast iron <br /> ❑Water Connecti ' con pair($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 Availabilitv Ezolanation: <br /> Contractor installed line to inside of house for future hook-up. <br /> Tlris line will be inspected by the Public Works Department. <br /> Reauired Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Addirional 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: $ ��U. �"U <br /> 2. STATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMTT FEE(Add Lines 1-3 Above) $ l d�J. v v <br /> � ONAL Il�tFOit�4ATIC)�+T—Y��TER A�EETEIt3 <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 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 aze,true and correct. <br /> Applicant: /� '" � � Date: �'I S—� <br />