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08/13/13 05:43 OLSONCONSTRUCTION 9524485289 p.03 <br /> . r <br /> a; <br /> ❑SAC Charge(2013 Rate=52,435.00) S <br /> (SAC Charge must accompany all sewer p�mit applications unless prepaid) <br /> (Orono City Staff can determine if applicable) <br /> (Tf not prepaid,a sewer connection p�mit wiU not be issued) <br /> �Sewe�Conn on 1 Disconnect i R ir(550.00/Per Stab) S •".z d•�� <br /> Pipe siDe � '� inches;material`�Schd 40 sir tested; cast iron <br /> �Water Conne�tion/Disconnect/Repair(SSd.00/Per Stub) J $ ��.>� C"� _ <br /> Pipe size�'�inches;material Schd 40 air tested; �/ copper <br /> ❑Water Availability For Future Hook-tJp to Water(SS0.00) $ <br /> Wa�g�Availabilitv Eanlanation: <br /> Contractor installed line to inside af house for future hook-up. <br /> This Line will be inspected by the i'ublic Works Department. <br /> Reauired Before Water Connection Permit is Issueti: <br /> 1. Issue Water Meter&Hom Per�nit <br /> Z. Any Additional Connection Fees Paid(If Applicable) <br /> Tssue Water Connection Permit: <br /> 1. Cotlect Permit Fce&Issue Water Connection Permit <br /> 1. SUBTOTAL of Permit Requested: $ (,.��� �.>�...� <br /> 2_ STATE SURCHARGE $ S,Qp <br /> 3. POSTAGE&HANDI,ING(Onty on Mail-In Applications) $__ �2.00 _ <br /> 4. TOTAL PERMCT FEE(Add Lines 1-3 Above) $ f�J°�. C/�� <br /> ADDYx�0�1.�I,Il�`FCJItIv�A�I41d--WA'TER M�T��tt.� ` <br /> ■ WATER METERS must be picked up and paid for at(}rono City Hall,these are on a se rate permit. <br /> � WATER METERS must be set and sealed by Orono Wat�Department (952) 249-4600, upon <br /> completion of ineter installatian. <br /> The undersigned hereby applies to the City of Orono for issuance o.f 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 /> Minnesota,and certi�es that all statements made on this application are,true and correct. <br /> Appticant: : � Date: <br /> �� �' _��.�t� <br />