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May 31 13 08:52a Westonka Mechanical 952-472-4961 p.3 <br /> � S5�''J1120i�3 08:47 3522494616 ��► ' '"""`' """` <br /> ❑SAC Cfiarge(2013 Ra�=�Z.435.00) � <br /> (SAC Charge must accompany a11 sswer per�nit appl�taticros untess prepaid) <br /> (Orono City Staff can deterrnine if�licable) <br /> (Ttaot prepuid,a uwer connectior pe��nit will rot b�'ss5ved� <br /> ❑Sewe�Conn �on!Diaconnect/TLepeir($SO.OAIPer Stvb) S <br /> Fi��e size�inches;+nateTial�Sehd 40 airtested: cast�roa <br /> ❑ Water Connectiati/Di�coaaecl/Repair(��f1.011lPe�Stub) S <br /> �'Ipe sixe � inchcs;materiaJ ''� Schd��air t�s�cd; copFcr <br /> ❑R'ater Availability For F�uture Hool�Up b Wab�er(S51L0(1) $ <br /> Water Availabilkv ExoIsrtatinn: <br /> Contractor insutllcd Sinc to insicic af housc for f�ture hook-up. <br /> '(l�ic line will be inspected by tha PubFic Warks 1�epartrnent. <br /> �P��aired B�fore aLer Conn_ection Pemiit is issued: <br /> 1. TFsue Watc�Mcte�8t Hom Permit <br /> 2. Aay Additional ConnectiortFees Paid([f Applicabk) <br /> icv�r Water Conneccion Permic: <br /> I. CoEloa Pctenit Fec&(ssuc Water Cormection�ermit <br /> 1, SULt'I'O'�AZ.of Permit Requested: $ <br /> 2. StATE SURCHARGE $ 5.00 <br /> 3. POSTAGE&HANDLING(On(y an Mail-Tn A�lplications) S 2.00 <br /> 4. TOTAL PERMIT FEE jA1dd Lines 1-3 AUpve) '� <br /> -- � -- .� T��i� 'L'.�FORMA�" �1'�� �� ��� —��`�-�=�_ =�.: <br /> te ;t <br /> • W ATER MLTERS must be picktd v�p an�paid for at Oremo City Hall,thes�ar�c or�a senars aeTnt <br /> • WA?ER MBTFRS mnst be set xnd senlcd by Orono wstes Dep�rtmcnt(952) 249-460Y, upon <br /> completior of rrteter issgfallation. <br /> The undoYsigned hereby a�plies to the City of Orono ft�r is5uance of a Utility Pcrmit,agrccs to do <br /> all work in striet aceordance w'tth the�rciinaa�ces of the City and the regulations of the Statc o.f <br /> Minnesota,and certifies diat a!1 statem ts made on t��is appliostian ar�,true and correct. <br /> � <br /> � �� �� �� <br /> �,ppliaaetk Date: <br />