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J <br /> FOR CITY USE ONLY <br /> ' City of Orono <br /> 2750 Kelley Parkway <br /> /o 4 `���� P.O.Box 66 Date Received: Permit# <br /> ��� <br /> t'>�r Crystal Bay,MN 55323 Approved By:(If Required): <br /> _. ,}9 j% (952)249-4600 <br /> CITY OF ORONO—WATER METER FORM <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department') <br /> GENERAL INFORMATION <br /> 1. WATER METERS must be picked up and paid for at City Hall. <br /> 2. If possible,fax in this application ahead of time;we will then call you and let you know we have <br /> the water meter in stock. Fax Number:(952)249-4616. Also,you can call ahead of time to make <br /> sure we received the fax,or to warn us that the fax is coming. <br /> 3. WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, <br /> upon completion of meter installation. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> ildResidential(May Require Approval) ®Commercial(Approval Required) <br /> IS/New Meter ❑Additional Meter—For: El1 Replacement Meter <br /> Job Site/Owner Information: <br /> Site Address: n 0 �j f/l o W OC <br /> Owner:II 11\i.I) 013or.) Mailing Address: 5cl Yom. <br /> City: La(19/--4 k E Zip: SS 3 S <br /> Home Phone: %5)-1-17 Lid.S 9 Alternate Phone: <br /> Contractor Information: <br /> Contractor:C.,14-YO e v`1 1)1 15 -43 Contact Person: ( u:4 h G:&rf jCv\✓ <br /> Address: I'60 B Wes+ Wayz4`64?JC State License#: 4/10-M <br /> City: L£wl) k e- Zip:55356 Expiration Date: 13(4-7 <br /> Phone: /Sa4-t7 3171.3 Alternate Phone: 6/,)- 8S S <br />