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FOR CITY OSE ONLY <br /> ' � City of Orono G <br /> " ¢ � Y.O.Box 66 Date Received:� D Permit# �� /' � ��� <br /> �Q��,, ��`�;1 2750 Kelley Parkway <br /> �" ar ►�� Crystal[3ay,MN 55323 Approved By:(If Required): <br /> � }, <br /> ����1j ,�ya��f (952)249-4600 <br /> \. sersoe/ <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 /> l. WATER METERS must be picked up and paid for at City Hall. <br /> 2. If�ossible,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 ineter instailation. <br /> TYPE OF PERMIT <br /> Check All That A 1 <br /> ❑ Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> � New Meter ❑ Additional Meter—For: � Replacement Meter <br /> Job Site /Owner Information: <br /> Site Address: � q� 1�- r� � ��2 W C,�,�-Q,f�� �V'e-- �r0 y�� (�/� SS35(o <br /> Owner: �� ��V�1o�CY12�'�-�� 1 ! Mailing Address: �6'7a �����-`-1�'t`�W�-�-(�lS <br /> City: ��(`D►'1� f�/�Il� Zip: �S3S �p <br /> Home Phone: 9'S•� —y�"1 (� - Dn3 Z Alternate Phone: <br /> Contractor Information: <br /> / L-�C � <br /> Contractor: ����M f7,� Contact Person: �� S v�` <br /> '/- ',,� 6�,38'o r� <br /> Address: �702 (�-�X�J N' State License #: - <br /> City: DJ�I � � Zip�7y`� Expiration Date: �' 0�� <br /> Phone: 7�?a-38��3� Alternate Phone: 719-3—y���� <br />