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Rus 24 07 02: 1Op Coppin 952*472*2316 p. l <br /> _ � Au� 24 0? Ol: l6p CusLoe Structures L7D 952-473-9041 p.2 <br /> DETERMlNING PFRIIQT'�EES <br /> a SAC CQac�ie(2007 Ra[e�Sl.fi7S.0� S <br /> (SAC C�rge mutt aecompmy all sawa p�mit applirations unkycs prepaid) <br /> (Ocono City Staff can det�tnine if applioable) <br /> (If not prepAid,a sewer ooaseclian pe�it xil not be as�eA) <br /> �s�c�o���cs�� .�� .. ` �v .�� <br /> , v ��-�;-�= <br /> w�e 8i� �c m.ie�t s�,a���a���;� <br /> (�'VPaler Conaat�o/Dkeobaect)Repair(S�OOIPe�gteb $ <br /> P��e si¢e mcl�e��ateria! scbd 40 air[eseed;�copp�� <br /> 1, SU87'dfALofl�cimilRoqualud; S <br /> 2. STA7'Fs 5URCHARGE $ s� ^ <br /> 3. NQSTAGF.dt�IANEHJiYa(Onh-an INail-in Appli�ttic�s) S 1.50 <br /> a. TOTAL PERMPI'FEE(Add Laxs I-3 Abm�e) S <br /> wunmoN�v.,nv�o��ow-war��Rs <br /> ■ wATER�I�TERS must be P��uP e�F�d for at O�a�o ciry Iiall,lhCso are oa a�eDarsle ner,o�. <br /> • R+A7E8 M�7'ERS�ast 6e set�d sesled by Oc+tao Watar Deps�cnt(95�Z49•46AU, qpon <br /> aromPfetion�laaler iratullatio�. <br /> Tlie uc�si�C1 hereb3'gPPlies co t}�City of Orano fo�issuaace ots UaalY pe�t.a�to do <br /> af1 worb e�s�ict a�urdanc�w�rh the ord'ut�of the Gity��n�lati�s af the State of <br /> Minnasota,rnd cesti!ies that aU sratenrmts made oa�s app}icadoa a�aue and coaoct. <br /> n <br /> Applicanr. ;��.'G3.:,.L.��r,.,,� Dabe: �'�.9 ��' s � <br /> � <br /> Resst Form <br />