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Feb 03 18 04:34p A.L.Sheremer Const Inc 7632677299 p.2 <br /> � . <br /> '������'.�'S <br /> ❑SAC Charge(2015 Rate=$2,485.00) � � <br /> (SAC Charge must accompany ali sewer pern�at applicazions�mless prepaid) <br /> (�rono City Staff can determme if a,pplzcable) <br /> (If not prepaid,a sewer connectien permit will nat be issued) <br /> � �Sewer Connection 1 Disconoect/Repair(SSO.00/Per Stub� s <br /> Pipe size inches;material ' Schd 40 air tested:, cast nrQn <br /> ❑Water Conaection!Disconnect/Repair($5p.00JPer Stub} $ <br /> Pipe size inches;material Sc�d 40 air testtd; copper <br /> ❑Water Availabitity For Future Hook-Up to Water($Sfl.00) $ <br /> Water Availabilitv Emlanation• <br /> Contractor instaUed line to inside of house for future hook-up. <br /> T#us lme witl be mspe�ted by the Public Works Depamt�tni. <br /> Required Before Water Counecdon Permit is Issued: <br /> ]. Issue Water Meter&Horn Permit <br /> 2. Any AdditionaI Conneetion Fees Paid(If Applicable} <br /> Issue Water Connection P it; <br /> 1. Collect Permit Fee&Issue Water Connection Perniit <br /> �,., ; <br /> �l <br /> 1. SUBTOTAL of Permit Requested: � � <br /> 2. STATE SURCHARGE � �.a0 <br /> 3. POSTAGE&HANDLING{Only on A�Iai!-In AppIications} $_ � / <br /> �� <br /> 4. TOTAL PERMI3'FEE(Add Lines 1-3 Above) g %,�' <br /> r <br /> r.% i i ' <br /> An�zTTON�,�a�T�o�v-u�A�R�TERs <br /> � WATER METERS must be picked up and paid for at Orono City Ha1l,these are on a�eparate permit. <br /> ■ WAT'ER METEILS must he set and sealed by Orono Water Department (952) 249-4600, upon <br /> completio�o[metcr installatia�. <br /> The undersigned �ereby appties to the City of Orono for issvance of a Utility Pecmit,agrees to da <br /> all work in strict accordance with the ordanances of the City and the regulations of tt�e 5tate of <br /> Minnesoia,and certifies that aIl staiernents made Qn this app�ication are,true and cornect. <br /> ` <br /> ) <br /> Applican - . Date: 7 �--�� <br />