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12/17/2015 09:57 7632592299 SCHULTIES PLUMBING PAGE 05/67
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<br /> SB"1�TE.R- � 3/4"METER- [� 1,°METER-
<br /> 5/8"HqRN - [] 3/4"F�ORN -
<br /> � 1"'HORN -
<br /> ❑ "WA7'�R ME'�'ER ('�'AFSR WILL AAV�Y'D ST�SPECfA.�,ORDTy�tEb 8c PR10E5 DET$RMINED)
<br /> 1. METER F.�E: �
<br /> 2_ HORN.FEE $
<br /> 3. TOTA.L PE�MTI'F�E(Add Lines i-2 Above) �
<br /> , ; CITY=USE ONLY �
<br /> "`Fvr Currer�t Pricir�g Refex to Current Year- 'VlTater Meter Pricing Chart*
<br /> BRAN p:
<br /> s�s X s�a
<br /> s1�: p sis" ❑3/4�� ❑ i" ❑Other �, 68759556
<br /> S.��AL#: ' IIIIIIIIIIIIIIIIIIInI�IIIIIIIIIIIIIIIIIIIIIIIIII
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<br /> �RT HIC#I-�#: � 1852952219 (if applicable)
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<br /> The unders,ignEci hereby applies to thc Ci.ty of Orono for issuar�ce oF a water meter permi�,agrees
<br /> to d�all work in strict accordance vvith the ordinances of the City and the regulationa of the State
<br /> of 1V�innesota,and certifies that all stateme�nts made on thi.s applieation are,true and eo.rrect
<br /> A.ppiicant. Date= � T
<br /> Ori,girurl; 1-Addre,qs File
<br /> MAke Copies For: 1, Utility Bill�ng Depar�ment
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