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�` DETER1l�11NI?�G F'ER�1iT FEES i <br /> ❑ S�1C CEzarhe(2016 Rate='�2.-SSS.Q(!) � <br /> ($.�1C'Charee musi accnn��pan��all seiuer p�rrnit application.unle::j�repaid�l <br /> (Urn��o C�it��Sta1�1 can deteri7tiuc if ap}�licable} <br /> (lf not prepaid, a seti�er cotuieccion permit tii�itl not be issued) <br /> � Setser Connection/�ixonnect 1 12rpau-(��O.t)0/Per Sri�b} � ��' � <br /> Pipe;ize_ inches_matcrial Schd=}0 tjir tested: ea:t ir�>n <br /> ❑ �1�atc�r C'onnecti�>n/lliscotuuct/Repair($�O.QO/Per Stub} S <br /> ___ — – _.- <br /> Yipe�ire _ inches: matcrial S�l�d-1C1 air fe�ted: ��p��er <br /> ❑ 1�'ater:A��atlabilit�� For ['�tture I{ook-[�p to !�'ater($50.00} �; <br /> —_. ___ ---- ----- _-- <br /> � ��'ater,1��ai1:iE�ili[�� I�:zptanation: <br /> i <br /> ' Contractor in;tulled line t� insidc of houae ior futurc hook-up. <br /> 7�hi�line��ili be in�prcted b��the Public i��ork�Departn�ent. � <br /> � Requircd Before 4Vat�r C�mnccti��n ['ermit i:l�.ued: <br /> � 1. t��ue 1��ater Meter& fIom Per-�nit <br /> I ?. t\n}�.AdditicnalCvnnec[ionFeesPaid(ffA}�plicablcl <br /> i <br /> I <br /> I Issue���'�it�r Connection Pcnnit: <br /> I. C��ll�et Pennit I=ec�� I:suc A�-ater Con��e�[ion P�nn�t <br /> I <br /> 1. St�STOT;�L of P�rmit R�yur.ted 5 _ � Q.� <br /> ?. S"1.A�I�L SliRCHf1KGL= S � p� <br /> �. POSI�AGE R 11�1NllLINCr(Only on 1�Iail-ln .Applieation:) S ?.O0 <br /> 4. 'I�O'[',�L P�R�tIT PI:E(�d�3 Lirles ]-3 AE�<��e) 5 ��. � <br /> ADDI1 ION�`1I_ INI�ORI��A�I�I(�N —��v'ATER ;��1ET�RS � <br /> d 0�'_1'1't?R 1�iE"I'ERS n�u�t be pic{;�d uE�and paid ti,r at Urone C�it�� FIall_thc;e are un a se�aratz�ennit. <br /> � ��ATER 11E7'I�RS ►izust be set and sealed b}° Orono V!'ater I)eparUnent (952) 249-4600, upon <br /> complcti�ti of ineter instaliatiun. <br /> �f}�e undersi�ned hereby applies tu tile Cit�� of�Orono t��i- i�suanec ot�a Utilitv Per-n�it, ,}�r�ees t� do <br /> al1 ����,rk i❑ strict accorclance ��-it1T the urdin�3ncc:s of�t{ie Cit}� an�3 thc re��ulations ol�the State ol <br /> Minn�tota, and certifies that all statements il�ade on tiiis applicati�>n are. true and c��rrect. <br /> �t�, � r : � � z <br /> . <br /> . <br /> !�pplicant: '� �;`�' �' .Sc�.w,��– l�r ��ct 1 � � [)ate: �> � ;�_, , ;� � � � <br /> — --� �_ <br /> [ . � � __ _ --- ____ _ <br /> ��� .. �•f', , f�. .���';`....� �;-�,y r -a .,� <br /> � <br /> ��f��/ `- <br />