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, Jul�6 �6 01:11 p Metro Earthworks 763-428-2212 p,2 <br /> ':;��;�`���;:. �.T.�;�:�,:,�__,.�.� z.;.*as::� <br /> �_�,� .x- __� '•_XcV _ ry -x,-�.--• - 'r�-:...a.:�. <br /> ���;-.r�; t� _ _ .,.c... �.�+++:'i,+�-:'-,-�tre_.r+.�rr:.e.�..,-- <br /> ❑SAC C6arge{2016 Rate=$2,485.00) S <br /> (SAC Charge must accompany all sewer permit appiications unlesa prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (If nat prepaid,a sewer connectian permit will not be issued) <br /> i <br /> Sew r oaaection ect Repair(�SQ.OWPer 3tub) S <br /> Pipe s�ze mches• a �ial Schd 40 air tested; cast imn <br /> ❑Water Conneciion/Dfi�onnect!Repair(SSO.00/Per Stub) $ <br /> Pipe size inches;material Schd 40 air tested; coppec <br /> ❑Water Availab�fty For Future Hook Up to Water(�50.00) $ <br /> Water Av$ilabillty Emlanatioo: <br /> Conhsctor iinstalied liae W inside of house for future hook-up. <br /> This line will be inspected by the Public Works Departmern. <br /> Reauired�efare Water Co�tion Fermit is lssned: <br /> 1. Issue Water Meter&Horn Permit <br /> 2. Any Add'etional Connection Fees Paid(If Applicable) <br /> I�spe Water Co,�n �tion PermiC <br /> 1. Collect Permit Fee&Issue Wafier Connectiun Peitnit <br /> t, SiJBTOTAI,of Permit Requested: $ <br /> 2. STATE SURCFiARGE $ i.00 <br /> 3. POSTAGE&HANDL�TG(Only on Mait-In A,pplications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines]-3 Above) S <br /> ADDITIONAL INFORMATION—WATER METERS . <br /> ■ V1�'ATER�IETERS musE be picked up and paid for at�rono City Hall,these are on a separate permit. <br /> ■ WATER METERS must be set aod sealed by Orono Water Department (952)1A9-46(10,upan <br /> compleiion o!meter installation. <br /> The undersigned herehy applies to the City of�rono for issuance of a Utility Permit,agrees to do <br /> all work in strict accordance with the ordinances vf the City and the reguiatior►s of the State of <br /> Minnesota,and certifies ti�at all statements made on this application are,true and conect <br /> Applicant• �.�� Date: �'� 7 <br /> �� <br />