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Oct-25-2005 03:53pm From-CtTY OF ORONO +A522494616 T-T06 P.001/002 F-869 <br /> � <br /> . • <br /> „��. <br /> , , •ti. '��.. � <br /> `'�,� t.. � � .�`�.'�'.�`� �' ' <br /> ..�r�N.1� �� k ti <br /> !�i r4 '• „i'll�� ..eu;�� <br /> .a d.jY. <br /> ❑SAC Charge(2005 Rxte=SX,450.00) � <br /> (9AC Charge must accompanY aII sewer permic applicauons unless prepaid) <br /> (Orono Ciry Staff can determine if applicable) <br /> (Yf aot prepAid,a sewer cunxection pecmit wW not bc issued) . <br /> �Sewer Connecti /Dis�' nAect/ p�ir(S35.00/per Stub) $ � �� — <br /> Pipe size inches;matenal Schd 40 air iested; cast iron <br /> ❑'R'ater Gonneetion/Disconnect/Ytepair(535.00/Per Stub) $ <br /> Pipe si2e inches;macerial Sehd 40 air tes�ed; casc iron <br /> 1. SIJBTOTAL of Peimit Requzstod; $- `� � ` �D <br /> 2, STAT'�SUItCT�ARG� $ .50 <br /> 3. POSTAGE&HANDI-ING(On1Y on Mail-Tn Applications) $ 1.50 <br /> 4. TOTAY,PEYZMTY`�'EE(Add Y-mes 1-3 Above) s�� <br /> r �� ,�, , . ��. ,�i.D��['.'�IQI�I�AI:TNF�6RiVIATION�WATER IviE1'�1�5�.���": . r>� <br /> � WAT�Yt NI�TERS must be picLed up and Paid for at orono Ciry Hall,mese are oa a se�te�e_rmit• <br /> • WA'�R ME'TE1tS must be set xnd sesled by Orono Water DepArtment (95Z) 249-4600, npon <br /> completion oi mecer in4callation. <br /> 7he undersigned h�ereby applies to the Ciry of Orono for issuaace of a Utiliry Permit,agrees to do <br /> all work in su�ict accordance with the ordinaaces of the City and the re�ulations of the State of <br /> Minnesota,and certifies tt�at all statements made cm this appiieation are,true and correec. <br /> Applicant:�(� � �`� _ Dace•IV� /"�i�� — <br />