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From: Bjom Vogen Far.:(866)442-0108 To: Fax: +1 (952�249-4616 Page 3 of 3 07/'15/2015 3:52 PM <br /> �� °��I,���J���d'x��,C:+�:}���ia���,_� <br /> ❑Sr�lt'Cttal'gC(1i0tfi R8#C=52,485.4p) � <br /> (SAC Chuge m�ist accQmp�rry all sew�r perm'st applications tanless prepaidj � <br /> (Orono Ciry 5taff can determine iE applicable} <br /> (If not prepaid,a sewcr cQnileetian perin�ikwiA not be issaed} h, � � <br /> ❑Sewer('o►�nection/Disconnect(Repxir(�50.4QIPer Sh�b) � " ' <br /> Pipe size,____,_„__incl�es:mat�ri;ii._____Schd 4Q air tested: cast iean <br /> �Wafer Connectior�;Disconnect/Itepuir($Sfl.Op/1'er Strab) '�� <br /> I'ipe size_ inches;materiaf Schd 40 air tested;_,.__,____cc+pper <br /> C � <br /> ❑Water 9vailability Far Huture fi�a�k-llp fa Wr►ter(5�50.�Q) $ � <br /> ��� <br /> Water Av�ulai�ilit�P:xai�o►a�ian: �--�lt'" <br /> � �� r <br /> Ccrntractor insEt�lled linc to inside of house for tuture hpok-up. 1 <br /> This lin�will be ins�ected by the Public W�rks De��rtn7es�t ��:��� � � <br /> � �,� �V � <br /> Require<i Befpre Waker Cannectic�n Permit�i5 Tss�d: � ( `��� <br /> � �...- <br /> 1. Issue ik'ater Meter&�Hom I�eznlit `~- <br /> 2. Any Additioi�al t'on�ectic>i7 Fees T'�id(If Applic�ble} ��� � <br /> `� � <br /> issue Wnt�r Conne,ci�ion Permit: t l,, <br /> 1. ColleeC Pern�it Fe�Bz Issue�k'ater ConnecCion Perrrtit <br /> �k � rr L`-. <br /> -- ----- �,�-'� ,� <br /> � <br /> !. SC1I3"1`07'AL of Pannrt Requested: $ <br /> 2. STA'3'E S[.�RC:HARG�; � 1.00 <br /> 3. �'C1S1`ACrE c�.���ANI7L1fJC'r(t)nly on Mai{-1n Applications) '� �2.�b______ <br /> �. 7'OT'A�L P6:RMIT FF;E(Add L,ines i-3 Abo�c) S <br /> `___� _��-------ADUITIONAI., I��Qt�V1�,:7'ICIN�W�7"E� METERS _s..__ ..�._1 <br /> W�7'ER MF'TC;ItS mnst be��icked up a�7d ptid For at Orato City Hall,tlaasi ar�on a�e�arate_..pernzit_ <br /> VV:�'I'ER MEfiEftS must be set stnd sea[etl by Ortrno W�►trr i�epa►�t�eient(iJ52}249-�#6q0, upon <br /> con�pletion o4'meter installation. <br /> T�he undersi��e�l lier��y a�plies to Clie Gitv���r,-crnr>for issuance of�Utility Pernzit,a�;re�s tcr do <br /> all wc�rk in st�-ict acco�:iat��e with t.he orc�inanees of the City arrd th� re�ula[ions nf t}�e 't�te s�f <br /> Minnesota,�nd c ' `� t all statement:;niad�on ih�s applicatic�n are,tnie��r7cl o�reci. <br /> r 1 � r.. <br /> / �� �,.- <br /> �.__. � <br /> �f._.____ �`, � <br /> 7 <br /> Applicant _..__y�_. ___ __._._ Date. -� �----- <br /> l <br /> � � <br /> F <br /> ��. <br />