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.- �s <br /> � FOR CITY USE ONLY <br /> ' ,���, City of Orono <br /> O , O P.O.Box 66 Date Received: Permit# <br /> �,s, 2750 Keliey Parkway <br /> a <br /> y �7�'�1,;<�. F Crystal Bay,MN 55323 Approved By:(If Required): <br /> ��,����o` (952)249-4600 <br /> CITY OF ORONO —WATER METER FORM <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> GENERAL INFORMATION <br /> 1. WATER METERS mus�be picked up and paid for at City Hall. <br /> 2. If ossible,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 Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Meter ❑Additional Meter—For: ❑ Replacement Meter <br /> Job Site / Owner Information: <br /> Site Address: o�� M(.�I^�'�L�l,c.�OD d � <br /> Owner: �r-� G �` Mailing Address: �� I"�� c�-�—��-�:� !'� <br /> c�ty: (��� ,�� z�p: `�� .SS"3 � I <br /> Home Phone: (�S Z ��-(7 � �I S ��-- Alternate Phone: �, �� 2 � �C�3 '� `( � � <br /> Contractor Information: <br /> � l ( � l c�/?� � '� ��r' � �,.��.`�t_!.� <br /> Contractor: � 5 , � Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: �Gt � � � � S�� � S��� Alternate Phone: 1 Z �c�� - ��j ��`-� <br />