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� � . <br /> ,__.�,-- ---- -__-- ---�_--- ------ ----------------- <br /> ' ------- I��:`['F.�ZI�/CIN1_�I�i I'F�.�'w��1I�' E=FFS ----� <br /> = -------------- ------- <br /> ❑ SAC Charg�(ZQ16 Itate=��,4'�5.00) $ <br /> ------------------------___�.__..___. <br /> (SAC Char�e n3t�st t�eco�npany all sewer perdzlat applications u;iles�prepa:d) <br /> ((�ronu l.ity Staff can deterrrine if'a�plicab�e) <br /> ([f r�ot prepaiti,d StR"CY COFkt]eCtl9�f�i�t'[iqlt WIII CIOt b2 1SSUla'l�) <br /> t <br /> ' S�sver Cc�nnection/I?isconnect/Repair($S{!.(�i}/Per Stab) � 5�i <br /> �'i�e s'rze 4 `� icic�ies; material X Schd 4f?air tested; cast iron <br /> [�' Water ConEaectiori%DisionEtect I�Y.e�iafr($SQ.00/Per Stub) $ <br /> Pipe size :r�cFies: makeria( Schd��J air tested; copper <br /> ❑Water Av�ilability F'or FE�tare�iook-lip tcr Water($50.OQ) $ <br /> - — ------------- ---------, <br /> ; V4'afier_A_v_a►labilite•_Explanation: ( <br /> I ' <br /> � Corftractor installed line�o i:�sid�of Louse for fi�h,�re hook-up. � <br /> iTh=.s line w:Il b�ir�spected i�v the Pu�lic Wa:ks Depactment. � <br /> � Requiresi Befgre FJ✓�ter Cum7ection Per�nit ss Issuee�: i <br /> � I. Is�ue�'✓ate�Meter Sc.I�en�Permit- - --- { <br /> ; 2. Any f�dd�ti�nai Connection F'ees Paid(If A��p�icablej I <br /> � i <br /> � Issu�;_�'Vater Coi���ection Pennit: � <br /> I �. Cotlect Permit l�e�;& Issue Wate:Corinection Permit � <br /> � - - ------ --- <br /> ;. SL�BTflTAY,of Permi#Requested: y �� <br /> 'L. STATE;SLJ�2.CHACtG� $ 1.U0 <br /> 3. POSTAGE 8r HANI)L[NG(Only on Mail-In Ap�rlica.:ons) � ______2.Ofl <br /> � <br /> 4. 1'�7t'AL PEIZMIT E�E{Adi3 Lines I-3 ,4l?ove} $ �J� �� <br /> - _------__------------------------------------------------------------------------------------------- --------------------------------------------, <br /> �I�)I)171�:�IAL 1l�EOI�1�It�.7�E(.)til --- ��%1�T'ER IYIET�€�.S j <br /> � W A.'I',£�R M1E'I'ERS n�ust be picked up and paid faz�at Oren�City HaIA,these are on a sepasate permit. <br /> • W'A'I'ER METERS must be set and seated by C)rono Water Department (952) 2�9-.�600, upan <br /> compietior�of rnetcr installatian. <br /> The undersi�ne�herebv appiies t«t��e (�ity of Orc�no f'or i5s�.�ance of a Uti[ity� P�,n�iik, agraes to do <br /> all work in skrict accordance w '�e or�iinances of Ehe Lity an�i the regulatioz�s of the State of <br /> Ming�esota, an �� rtifies that a s �ments r�lade an this a�pli�;ati€�n �re, true and corrcct. <br /> Applican . -- — ----------- Date: ��-'�? 7�� �o <br />