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4 <br /> FOR CITY USE ONLY <br /> ,9,c)4. City of Orono <br /> O <br /> P.O.Box 66 Date Received: Permit# <br /> ,...F 2750 Kelley Parkway <br /> • Crystal Bay,MN 55323 Approved By:(If Required): <br /> (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 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 meter installation. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> Residential(May Require Approval) ®Commercial(Approval Required) <br /> jNew Meter ❑Additional Meter—For: ®Replacement Meter <br /> Job Site/Owner Information: <br /> Site Address: Lf 01'-1 IJ9✓ . jl re f�r(V <br /> Owner: Fired-JDkVA Mailing Address: CJS Vat LW <br /> city: M(Avn,6y"s4- Zip: SG5b <br /> Home Phone: 70-2)-1'33- SD6-0 Alternate Phone: (0(2--)01-514 <br /> Contractor Information: <br /> Contractor: 1 th' .l9I 66I--i J -6115 Iitact Person: <br /> Address: Zip S W Pin 6 ) State License#: •t� • �' <br /> City: h^ti Zip:_gZjet Expiration Date: <br /> Phone: '1�2- tiq 141 Alternate Phone: `15?---2-(51)_ - <br />