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� FOR C1TY USE OnLY <br /> ,�p� City of Orono � <br /> P.O.Box 66 Date Received: ,I -��`l t Permit# <br /> ��;�_;,,,� � 2750 Kelley Parkway � h� <br /> � ��`�'�,�:'�. � Crystal Bay,MN 55323 Approved By:(If Required): ; � <br /> ����`�,J��o� �9s2�2a9-a600 �?�� � �� , <br /> ` l <br /> �� <br /> CITY OF ORONO—WATER METER FORM <br /> (*Note:Some permits may require approval by the Building Official and/or Public Worhs Department*) <br /> GENERAL INFORMATION <br /> 1. WATER METERS must be picked up and paid for at City Hall. <br /> 2. If possible,fax in this application ahead of rime;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 Apply) � <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> � New Meter ❑ Additional Meter—For: ❑ Replacement Meter <br /> Job Site / Owner Infornlation: <br /> Site Address: ///5 G(Y��< ����j�e.- i7�5 5 <br /> Owner: Mailing Address: ►�OC�Y��G. ���4� <br /> City: ��6�0 Zip: �5 3�� <br /> Home Phone: Alternate Phone: <br /> Contractor Infonnation: <br /> Contractor: M Contact Person: (; ��� <br /> Address: �d�z �A����(J-t, ��/l,q�State License #: L��� �Q --�� <br /> City: PIy�D(,�� � Zip: 5��7ExpirationDate: �2�"�1�10 <br /> Phone:(7�,3� 7��' ZZb � Alternate Phone: ���2 � Z2/— �S`c� <br />