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Jan 07 10 01 : 56p p, Z <br /> �— DCT�12M�1�11NC PERMIT FT:i:S <br /> ❑SAC Ch�rgc(20118 linte=Sl,Sz5.n0) S <br /> (SAC Char�!�mu5C i�eCOmpany all scwor permit applicalions unlc��pror,u�d) <br /> (Orono City Slu(�can dolcrmine if:�plicabl�) <br /> (IfnaC prepaid,0 5�vvcr canncction pet'mit wil!not be i�9sued) <br /> ❑tirwer Coonecl':un/Dirconnect/ILep�ir(S3S..OU/k'er Slu�} $ <br /> Pi��c cizc in�bes;matcrial Schd 40 air tcstcd;... _casl iron <br /> ❑Wutcr Conucction J niaconnect/Repair(535.4(1/Pcr Stub) $ _.,_,.._ <br /> I'ipc sizc ,inches;matcrial , 5chd 40 air tcstc;d; copper <br /> 1. SUS'fOTAI.of Pcrmit Ctcqucstcd: $�_ <br /> 2. S7'ATE SURCHARGT: S •5�1 <br /> 3_ POSTAGIi&I-IANDLiNG(Only on M�i1-�n,A,ppliciitionc) $ I.SO ____ <br /> 4. TaTAI,l'�RMIT FEC(Add 1_incs 1-3 Abuve) S <br /> ADDITIONAL 1NTORMA"C10N --WATfyR MET�,RS �� <br /> . - WA7'ER 11��1'rILS must bc pickecl up and paid for aC Oroao Ciry liall,thcse are on a s�aratcpermi[, <br /> • WATER 1VI1:'1'E1tS mast be sc� and cealed by �nlnu wster Depurtmcol ('lSZ)249-4G00, upon <br /> COrtAplCtion of inetcr instaUAtSnq. <br /> The undersiUncd hereby upplies to thc City of Orono for issuance of a Utility Permit,agrees to do <br /> all work in siriet.�.ccardancc wiih thc ordinanccs of lhe City aod tho rcgul�tions of tho �tatc of <br /> Minncsota,ancl�eartiiic,that all-sttncmcnt�madc on this applicartion;3re,trut and corrcct. <br /> � r� � 1 <br /> � , - - ,�/ ,�, J, � <br /> �PP�icant:.. � :� .,�' � -� ``�( (y��� .. ..... w _� Dat@:�„J� / �./ <br /> �-J <br />