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May 29 14 08:24a Westonka Mechanical 952-472-4961 p.2 <br /> CJ��LD/ Gqlv Cr1:10 7�CL�174b1U E,1 I Y Uh' UKUf'�U NH(]t b1/bl <br /> � �ETERNiININ�G PE�I'T FEES <br /> Q 5AC Chirge(Z0�4 Rabe=5�2�485.00) S <br /> (SAC Ghargc m.ust acco�trpariy all sewer permit apptications uniess�re.�aid) <br /> (Omno Ciry 5[af�can �ece*nzmc if7lppiicable) <br /> (l£aat prepRid,a�ew¢r connectialn permit w(1)not be isaued) <br /> �Sewer Conn on/Dil�onnect/Repair{$SQ.QO/F'er 3tab) S <br /> Pipe t�ze�inci�es:matcnal`�5chd 4Q aiz usced: c�rt iron <br /> �Water Conneetinu 1 Tlivm�necc I Rcpxir(5513.00/Per Stub) � <br /> ��� TApe size�inches;material ,�C/Schd 44 air testEd; capper <br /> ,�� <br /> 0 Water Av■;l■bitity For F�tare Aook-lip t�Water(35(IAO) S <br /> Water Avu'It�bilitv E�[plagatian: <br /> Con'.raccor in,s!allcd iine to inside of housc far future hook-up_ <br /> Tfiis linc wiI[be inspccted by thc Public works Departmen�. <br /> �Lequiced Before Water ConncctiogFermit is Is�u�d: <br /> 1. Issue Wa*.er I�eter&Hom permit <br /> Z, p,,ny qddi�ooal Connccdan Fecs Paid(.[f Applicabls) <br /> I55uC Watef COil11CCLQn PcSmti: <br /> ,, Collxt Pe-mit Fce&Ixsue Wa�er Connectian Permit <br /> 1. SUBTOTAL of PermiG�equestcd: � <br /> 2. STRT'E SrJRGHARGE S 5.06 <br /> 3, P05TAGF&}�.4I��D�TNG(dr11y an Mail-In Applicatiat;s) $ 2.04 <br /> 4. TOxAL PERM�'i'FEE(Add Lines 1.-3 Above) S <br /> AI3DI'I�O.NAL TN�+4.R1'v1ATI0N—WATER METERS <br /> ■ WATER M'E'TERS:nust be pick�d up and paid for�.I Orcmo Cily K�SJ,theSC eTC OA a,c�,epargte ot_CrX3i1. <br /> • WATL+R h�.ETERS mu9t be aet 8nd sealed bp OrOt�o W�ter Dtprrtinent (952) 249-d600, npon <br /> eompLetioAt otmeter islstallation. <br /> 'I'hc undersigned hereby applies to tbe City of 4rono for issnAnce c•f a Uri�ity Pe�it,s�rees to do <br /> a1a work in stn�ct aecordance with the ord�nanccs of t]�e City and ihe regulations a�t3+e State of <br /> Mitinesota,and certifies thaC a]I stptements mede vn thic applicatiom are,true a�d correcr. <br /> App2ieartt_ � Date� 1 �' -��,~ <br />