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06/18/2014 14:19 952-955-5071 BURNS EXCAVATING PAGE 04 <br /> F:/' <br /> . . � „n,�... . :�'., �t;�r,!�. <br /> , .:M, ��i"' <br /> a SAC Charge(2014 Rate=$Z,4R5.00) � <br /> (SA.0 Cbor�e must accompaJiy a11 Sewer permit appJications unless prcpaid) <br /> (Orono City Staff cata determine if applicablc) <br /> (If»ot prepaid,e sewer con►�ection permit will not be Kssucd) <br /> �wcr Connedion!Aiscot�nect/Repnir($50.00/�"er Stub) $ <br /> Pipe size inches;ma�ria.l �chd 40 air tested; ca,et iron <br /> ❑Water Coaqectio�/pisconnect/Rep�i�'($SO.Ob/Per Stnb) $ <br /> Pipe size inches;material Schd 40 air tested; copper <br /> ❑Wntcr Availability For Futurc�Ynok-Up ta Water($50.00) $ <br /> Water AvailAb�uLtv'Exvlanntion: <br /> Coetractor installed linc to ins�de of house for futurc hook.-up. <br /> This]inc wil)be inspected by the Publia Works T�epartment, <br /> uirad Before Wate nnection Permit is Issued: <br /> 1. Issue Water Meter&Horn Perm,it <br /> 2. Any Additional Connection Fecs Paid{IfA�plicable) <br /> a��ue Water Connectian�cxmi�: <br /> 1. Collxt Petmk Fee c�Issue Water COnqection Permit <br /> t. SUBTO'I'A,�,of Permit Rcquostcd: � <br /> 2, S'CATE SURCHARGE $�5_00 <br /> 3. POSTAGE Rc HANA�.tNC(Only on Mail-In Applications) $ 2.00 __ <br /> 4. TOTAL PEl�1vXX'�"F�E(rldd Lines 1-3 Above) � <br /> A:D�T'Y"C��`�TAL TN-FORIv��'T`�'f��l'-11V�1TER N�TER� <br /> ■ WAT�R M�TT'R$must be picked up and paid for at Orono Ciry Hall,these are on a sevarste�Er+��it. <br /> ■ Wi1,'I'��t ,METERS must be set and scaled by Orono Wate�' Flcpnrtment(952) Z49-�60(1, upon <br /> completiun of ineter�stallntion. <br /> The un.dersi�ned hereby applies to the City of Q,rono for issuan.ce vf a Utitity Permic,agrees to do <br /> all work in strict accordanee with the ordinances of the City �,nd the �regulations of the State of <br /> Min.ziesota,and cert'sfies that a11.statements mad.e on th.i.s application are,tnie and correct. <br /> �� , <br /> Applicant: �'�'�"' � Dat�: ����f,� <br />