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�Sep Q� 13 01;04p Westonka Mechanical 952-472-4961 p.3 <br /> 99/83/2013 10:18 4522494616 t�urvu rr.au� ut�uc <br /> � . . .S�E�'ERNffl�1tIYG.pEfLM���E�S� ��:: . <br /> ❑SAC Cfur�e(2013�tate=SZ,435.40? a <br /> (5AC Chazge must ac�omp$ny a�l sewer permi:apptications unlass prepaid} <br /> (Orona City S�af;can determinc if applicabk) <br /> (If not prepaid,a sewer ec►nneaxion permit wiII not be issaed) <br /> LX,1 ,SBwer COa aCStio�/Di9cpRqfCt/��lir(f$Q.Op/pt�5tub) S <br /> ��� nipe size��tehes;rnatcrial�Schd 40 air tested; cast iron <br /> ❑Water Cannectioa I Disconncct/Rcpair(�Sp.Op/Pcr Stab) g <br /> Fipe size inches;matcrial Schd 4C air tesud; eapper <br /> ❑ Water AveikabiGtr For Futare Hook-Up;o water(SSfl,pp) a <br /> Water Availsbi�itX„Fxnlanation• � <br /> Cantrac;or installed tine to inside of hwse for future hook-up_ <br /> This Line wil[bc inspcctcd by th� Publie Works Depertmeni. <br /> Required$cfore Watcr G�r��cctiort PErmic is►ssued: <br /> � 1. Usue Weter Meter&Hom Permit <br /> z- Any Additionat Connection Fees paid(lfApp2i�eble) <br /> � ]ssae Watcr Conncction Permit: <br /> 1. Collect Permit Fee&lssue Water Connection permit <br /> I. SUBTOTA[,afPermit Requ¢sYed: � <br /> 2. STATE SURCHl1RGE S 5.00 <br /> J, POSTAGE&N.ANDLNG(Orly on Maik-In Applicatioas) a Z,pp <br /> 4. TOTAL pERMIT F'EE(Add Lines t-3 Abovc) g <br /> ADDITIONAi�INFORiVIA�'i0N—WATER METERS <br /> • WATF,R MF.TERS rnust be picked c�p a�d paid forat prono Ciry Hal1,these are on a stparat_e ncsmit, <br /> ■ WATER METkRS must be set end 9tsled by Oroao Water bepartment (952) 249-46f10� upon <br /> camplctioa of inetcr inxtallation. . <br /> The undersigned heteby appfies to the City vf Ororto for issuance of a Utiliry Perm'rt,agrees to do <br /> all w3tk sn sttict accordance witl� the ardi�anees �f the City and the regulations of tt�e State of <br /> M.innesota,and certifics thRt a11 5CiitCr.►ellts Oft�I715 S(}�1]lC3tiOfi Sl'E,tNC fll1fJ COi��I. <br /> e <br /> Applicant: D��:�r � �+J 3 <br />