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FOR CITY USF,ONLY <br /> City of Orono <br /> �-Q�� P.O.E3ox 66 Date Received: ✓� /kPermit# ZC��� `L'L'� 7�3�� <br /> 2750 Kelley Parkway c� <br /> Crystal E3ay,MN 55323 Approved By:(If Required): �.�/ <br /> (952)249-4600 <br /> a a <br /> Z h <br /> � L� <br /> �,,x�sH��� CITY OF ORONO—WATER METER FORM <br /> (Note Some permits may reyuire 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. If possible,faac in this application ahead of time;we will then call you and let you know we have <br /> the water meter in stock. Fas 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 A 1 <br /> �Residential(May Require Approval) ❑Commercial(Approval Required) <br /> � New Meter ❑ Additional Meter—For: ❑ Replacement Meter <br /> Job Site/Owner Information: <br /> � <br /> Site Address: 7� % �`'�"�` '��'' �./'' c�t' <br /> � <br /> % �..�� � .�� ' � <br /> Owner: ,t�r �_c>_�z� a.�i' Mailing Address: G:✓/� ,E,Ycr.� _C��v,�� <br /> Ci d%// /�" Zip: �r5��� <br /> �� � <br /> Home Phone: �-„2�'��'`,�'�'�� Alternate Phone: <br /> Contractor Information: <br /> Contractor: .�.�,� ,lr�i/�'�C�a-� Contact Person: '' <br /> , --, , <br /> Address: /` � i�C� State License#: p C_ Sl�� <br /> , ' <br /> City: �-�-��_._- Zi�� �Expiration Date: �� Jl��/�� <br /> Phone: j�?5"���>�����/ Alternate Phone: <br />