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, 11/�9/2011 69:53 7635193932 PAGE 02/02
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<br /> ❑3AC Chorge(2011.RAte=$2,230.00) S
<br /> (SAC Charge mvst accompany all seuver permit applications unlesa prepaid)
<br /> (Orono City Staff can determinc if Applicable)
<br /> (l.i not prepRid,s aewer cooncction permit�vill not be issqed)
<br /> Sc�vcr Conee on/Discoenc ir 50.00/Per Stub) S
<br /> Pipe 4ize�inches;materia Schd 40 air tested;„_cast iron
<br /> ❑Wntcr Conaeciion/Di�vconaect/Repsir(550.110/Per Stub) �
<br /> Pipe si� inches;material�Schd 40 air tested; copper
<br /> �- -- - - Q W�tber Availability For�tarc Hook-Up to Wnter(550.00) $
<br /> Wntcr Availabilitv Exnlaaatiolt:
<br /> Contractor installed linc W inside of house for fuNre hook-up.
<br /> Thig line wll)be inspected by the Public Work9 Aepartrnerrt.
<br /> ired Bcf o n 'an i i ued-
<br /> 1. ]ssue Water Meter&Hom Permit
<br /> 2. Any Additianal Crnmation Fees Paid(ifApplicable)
<br /> e Coruo P 't:
<br /> 1. Collect Permit Fee&Issue Water Connection Pertnit
<br /> 1. SUBTOTAL of PertniR Requestcd: $ , � ' C�
<br /> 2. STATF SURCHA,�tGE $�, S.00�,,,,T
<br /> 3. POSTAOE&HANDLIIVG(Only on Mail-In Applications) $ —�:69
<br /> 4. TOTAL PERMT�'FEE(Add Lines 1-3 Abovc) S S�• ��
<br /> AUDITION�L INFORN�,A�,Tf01'�1-WA,T��t METER3
<br /> � WA�'CR MET�RS must bc picked up and paid for at Orono City Hall,these are on g,sgpa, a ermi�.
<br /> ■ WAT�R METERS maAt be set and �cnled by Oroeo WAtcr Department (95�) 249�4600, upon
<br /> completiod otmcter inRtallAtioa.
<br /> The undersigned hereby applies to the Ciry of Oronv for issuance of a Utility Pe:rmit,agrees to do
<br /> all work in striat accordanc�with the ordinances of the Ciiy and the regulations of the State of
<br /> Minnesvta,and certifaes that all statements made on thls application are,true and correct.
<br /> Applicant:
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