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a � <br /> FOR CITY USE ONLY <br /> O4�,►` City of Orono 7/ /� �1 � <br /> `�'O P•O.Box 66 Date Received.a 7(� Yermit# �U7��/Q � <br /> �:�s,e„�,, 2750 Kelley Parkway <br /> � ,�1�'�<'��. � Crystal Bay,MN 55323 Approved By:([f Required): <br /> a������o (952)249-4600 <br /> CITY OF ORONO-WATER METER FORM <br /> (*hote:Some permits may rcquire 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. Ifpossible,fax in this applicarion 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, ar 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 Apply) <br /> �]Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Meter ❑ Additional Meter—For: ❑ Replacement Meter <br /> Job Site/ Owner Information: <br /> Site Address: <br /> � �. � -� ����� �� �-�, ��� <br /> Owner:�C%��'t ��/'�?� f�v� (� �-�{� Mailing Address: ����`�� ��s-� r, ��' �� <br /> City: �%�,'����� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor:���-'�� ��"'"�' "��w�— Contact Person: � ��'`'l ��- ���- <br /> �.� ��-�'� � <br /> Address: ��-����S� �; �E ' State License#: ��1 <�-� <br /> City: �c_��� � Zip: �5 S �'°�Expiration Date: �� � � <br /> Phone: � � z �`� �' -��� `�� Alternate Phone: �L�5 ��3`� ��S � � <br />