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01/04/2015 04:46 9528947972 LAKESIDE PLUMBING PAGE 01/02 <br /> �9�•37 <br /> �'h 'TI'Y T18F ONL�' <br /> �/"1�> Cfry 0�01'bIl(1 J 7 �/�� � �,�/� <br /> ��'vj.� I`,O.l3ox 66 � Deite RCCe cY; PCII7111'��/ f/W�� <br /> � 2750 Kc1ley 1?�rlcwfly — <br /> Cry5lttl Dny,MN,5,5323 �pp1'OVCd By; jf ReqiiirGtl)� <br /> (9$2)249-4G00 — <br /> 5 ti <br /> � �� C�TY Oi+ORONO—W,ATER MET�Tt FORM <br /> {���.SH O� (+�Notc:Somc�crmitS mny rcquirc n��pr�val by lhc Buildinp_Uflicinl�nd/or Puhlic W�rks Dc�,�hmcnt <br /> � �1 <br /> ,GEI�]E:I�AL ThTf'C)�iv�ATIt�N <br /> � ,�� <br /> 1. WATER METERS must bc picked vp nt�d pxid for at Cily H111, <br /> 2. ff psp $I��E,fc�x in this�tpplication�.hefld of time;we wi11 then c�ll you a.nd lct you I<now we havc <br /> the water meter in slock, Fax Number; (952)249-4�1G, Also,you can caii ahcad oftimc to ir�ai<e <br /> sure wc rcccived tJte fas,or to w�rn us Chat the f�x is comin�, <br /> 3. WA.'�'�� M�'i'ERS muel bc set anc� scaler� by Or»no Watcr pepartm�nt (9Sz) Z49-9600, <br /> ��pon;Cotztpletion of inetcr iastall:►tion. <br /> Tvr>E o.r�ErI.NrTr _ � <br /> Chec.k�1T 7'h�t A,ppl�� <br /> � , <br /> Resiclentiel(Mny Rec�t�ite npprov�l) [�Commercinl(Approval Required) <br /> ew Meter ❑AdditianAi Metcr—F'or; „_ ❑ I�eplfl.ccmenl Metci <br /> ,iob Sitc/Ovvner lnfarmation: <br /> ��,�������SS: a�os _. x�,�.� �� <br /> ��,.. . ^_� <br /> Owner: �C.���- l�.J + (1� 1Nailing nddress� <br /> City: �i�; <br /> Home Phonc: AlternaC� Phone: <br /> Coi�tractor`Tnfarmation: <br /> Contractor: i i ee�, � c�/�'`-' <br /> ��'S.�J��fr1_ _ Contact person: � <br /> �lddress: )�`I(v0 z.�n�'wn ��� State; License�#: �9�0 C� <br /> Cit;y: ,�c.�.�4- ¢.. Zip:$.537� 1�xpir�tion Datc: ��/ /�_ <br /> Z_`b`ry-'�100� �-�--� F� <br /> Pl�onc: �Jr Alternate Phone; �'Z � (�j �"J� � <br />