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08/21/13 12:17 OLSONCONSTRUCTION 9524485289 p.03 <br /> ❑SAC C6xrge(2013 Rate=52,435.00) $ <br /> (SAC Charge must accompany all sewer permit applications untess prepaid) <br /> (Orono City Staff can determine if appiicable) <br /> (If not prepaid,a sewer connection permit will nat be i�ssued) <br /> �Sewer Conne¢tioa/Disconnect/.Rep,nir($50.00/Per Stub) $ �r�-%'�� <br /> Pipe size_�inches;maierial �' Schd 40 air tesied;___cast iron <br /> �Water Connection/Disconnect 1 Repair(550.00/Per Stub) / $ \��1� <br /> Pipe size�" inches;material Schd 40 air tested; ✓ copper <br /> ❑W ater Availability For�'uture Hook-Up to Water(550.00) $ _ <br /> Water Availabilitv Exolanation: <br /> Contractor instalIed line to inside of house for future hook-up. <br /> This line will be inspected by the Public Works Department. <br /> Reauired Before Water Connection Permit is Issued: <br /> 1. Issue Water Meter 8c Horn Permit <br /> 2. Any Additional Connection Fees Paid(Tf Applicable) <br /> Issue Water Connection Percnit: <br /> 1. Collect Permit Fee&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: S �V C.J ,�)� <br /> 2. STA'i'E SURCHARGE $ 5.00. <br /> 3. POSTAGE&HANDLING(Only on Mai(-In Applicaxions) $ �2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S / �r/��.�� <br /> AT.�DITIE.�ATAL 1�TF"�IItMA`TION`-`-VVAT�R�'C��2S <br /> ■ WATER METERS must be picked up and paid for at Orono City Halt,these are on a se�a.raie,permit <br /> • WA7'ER METERS must be set and sealed by Orono Water Deparhnent (952) 249-4600, upon <br /> compietia►of ineter installation. <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Miruiesota,and certifies that all staternents made on this application are,true and co ect. <br /> Applicant: ��';��(�(�'� (/L���,�/ _ � y <br /> Date: <br />