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Sep 17 13 07:36a Westonka Mechanical 952-472-4961 p.3 <br /> 09/16/2013 13:02 9522494blb <br /> (3 SAC Charge(3007 Rate=$1,675.00) S <br /> (SAC Charge must accompany all sewer permit applications unless repaid) <br /> (Orono City staff cast downine if appkabie) <br /> (V not prepaid,a sewer connection permit will not be issued) <br /> wer Ga oa 117risconnecc I (535OOIPer Smb� S <br /> (( Pipe size iec6cs;material SCbd 40 air test; Miff= <br /> —f3-Wster Connection!Disconnect/Repair($35.091Per Stub S <br /> Pipe sine .�- irwAcs;materild Schd 40 air tested;�copper ,e? <br /> 1. "TOTAL of Permit Requested: $� <br /> 2. STATE SURCHARC`rE S 5 <br /> 3, POSTAGE&HANDLING(Only on Mail-In ApplicaSions) $ L� <br /> 4. TOTAL PEERMIT FEE(Add Lines 1-3 Above) S <br /> ���}_ �Gb iiyµityuti�r�f 1' fin, <br /> ► <br /> WATERMETERS must be picked up and paid for at Orono City Fall,these are on a s„parate 1=� <br /> s 'WA'T'ER KETXRS must be set and sealed by Orono Water Departmeut(952)2494600,upon <br /> completion of meter installation. <br /> The undersigned hereby applies 10 the City of Orono For issuance of a Utility Pcrwdt,agrees to do <br /> all work in strict accordance with the ordinances Athe UY and the regulations of ate State Of <br /> K wesota,and cea dfies tho.-all smtemcstiS a:* n ig application are,'true and correct. <br /> Applicant. Date: 9—pl, <br />