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12/17/2015 09:57 7632592299 SCHULTIES PLUMBING PAGE 07/07 <br /> 5/8"METER- ❑ 3/4"METER- <br /> 5/8"HORIV - ❑ 3/4"HORN _ ❑ >>,�x�R- <br /> ❑ 1"I�QRN - <br /> � "WA,TER MET�R ('x'NE$F,WILi,llnv�TO e�SPECrpL oRAETt�D&ru�CES�ET�RMnvF;D) <br /> 1, METLR FFE: $ <br /> 2. HORIV F�� $ <br /> 3. TQTAL PER�IT F��(n�d Lines 1�2 Above) � <br /> C�TY-�I�E UT�L"�' <br /> *For CurrenC Pricing Refer to Current Year- Water Mcter Pricing Chart * <br /> BRqND� <br /> 5i7E: []S/8" ❑3/4" „ <br /> ❑ � ❑Other °° � <br /> s�Rrn�.#: �f a 7- � �P � <br /> �RT H�GH#; III III IIII I III I IIIIII I I III III � <br /> 1850562758 (if appl9cable} <br /> y4�►T��T��1T'���1�.Tf�k'�0��►'�C,��1'�'`W'�°�R�E'T�?R�� � ' , <br /> Thc undcrsigned hereby applies to thc City of Qrono for issuance Of A water rt�eter permit, agrees <br /> to db all work ir� strict secordance with the oz�dinar�ces ofthc City and the regulations o'Fti�e State <br /> of Minnesota,a�d eertifies th�t all statements made on this applieation are, true and correct. <br /> Applican • <br /> Dare:—�/� D <br /> Orfgrnal.• !-flddres.e!"iJe <br /> Make C'opies For.� J- Utrlity BillirrR Deperr!»�en7 <br />