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�' FOR CITY USE ONLY <br /> � � City of Orono ` <br /> �� �� P•O.Box 66 Date Received:���� ���"�Permit# �C'UC�' d���� <br /> .�, , 2750 Kelley Parkway <br /> � ��l'� �r�:_ Crystal Bay,MN 55323 Approved By:(If Required): <br /> +� r�,�.� (952)249-4600 <br /> iqar"�I,f� 4� <br /> ��o$ <br /> CITY OF ORONO–WATER METER FORM <br /> (*Note:Some permits may require approval by the[3uilding Official and/or Yublic Works 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 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 A 1 ) <br /> '�Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter <br /> Job Site/ Owner Information: <br /> Site Address: �� � � �7ff�,�, <br /> Owner: �.�v,E'�� Co/`�.�r4�ei:�i� Mailing Address: <br /> City: �CO`J v Zip: <br /> Home Phone: � ��' �7��- �-! Z-Z � Alternate Phone: �� <br /> Contractor Information: <br /> Contractor: ��'�'✓1���� Contact Person: ��� ��{7`/�� <br /> Address: �j�S� �53 � �� State License #: o �e ��, �� <br /> /�–._._. <br /> City: ��1J Zip: Expiration Date: ��j ,�7� <br /> Phone: �����1(� �/y�% � Alternate Phone: �— <br />