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I • <br /> F4 -c!,T 17EaDMA <br /> c 5%`I'8\ <br /> City of Orono <br /> LIQ• OP.O.Box 66 :Date 4000 <br /> 2750 Kelley Parkway s <br /> o- : Crystal yMN 5 32; 4pPOY.ed 03 {I41 4 rod) <br /> (952)249Ba4600- <br /> CITY OF ORONO—WATER METER FORM <br /> (*Note.Some permits may require approval by the Building Official and/or Public.Works Department*) <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 /> y s a <br /> [residential(May Require Approval) ❑Commercial(Approval Required) <br /> 121 New Meter [3 Additional Meter—For. ❑Replacement Meter <br /> Site Address: L1 "V J 611t-r— V CfAl <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Vbn� n ac) d#. ?=?. iso. <br /> Contractor: �aN, <br /> - �J�.]f t, aD) .3 )34, Contact Person: <br /> Address: ,� ' i State License #: ¢534 <br /> City: Pk9}1101414'1 1 Zip:55141 Expiration Date: 12'31. 7011 <br /> Phone: 1( 415. 12 L' Alternate Phone: `7/, 2' .4-.3 <br />