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� <br /> O C Y USE ONLY <br /> Cit of Orono � � '^� Q <br /> �-O� P.O Box 66 Date Receiv�c�, � Permit�C/ U <br /> � 2750 Kelley Parkway <br /> Crystal Bay.MN 55323 Approved By:(IfRequired): <br /> (9�2)249-4600 <br /> �, � <br /> y ` <br /> F� <br /> �KESH���G CITY OF ORONO—WATER METER FORM <br /> (*Note:Some permits may require approval by the B�ilding Official and/or Public Works Department <br /> «� <br /> GENERAL INFORMATION <br /> 1. WATER METERS must be picked up and paid far 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 ineter installation. <br /> TYPE OF PERMIT <br /> (Check All That Appl ) <br /> ❑ Residential (May Require Approval) ❑ Commercial (Approval Required) <br /> �New Meter ❑ Additional Meter—For: ❑ Replacement Meter <br /> Job Site / Owner Information: <br /> Site Address: a 6 pl 5 �NS ��� �� <br /> Owner: S��nL b�.y �Id'� MailingAddress: <br /> City: ����r�a Zip: <br /> Home Phone: Alternate Phone: <br /> Contractar Information: <br /> ,�y� � � <br /> Contractor: I����.�Sro., r j�5�,��/�r��h5 i,�;Contact Person: / �� �l� `� � lD<<-1�'�S�r <br /> Address: Y�a y �ckc�,'� �1�. �� State License #: P/��6 aZ 3� � <br /> City: 5�. ����4c1 Zip:Sr"31fi ExpirationDate: �oZ - 3�� � y <br /> Phone: ��,�j ' ���� ' ��/�( Alternate Phone: ��,� ` �3 �� ���6 <br />