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FOff qffY SE ONLY <br /> Q City of Orono ^ /� /� <br /> P.O.Box 66 Date Received: Permit#�10L501`�0 <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Approved By.(If Required): <br /> (952)249-4600 <br /> CITY OF ORONO—WATER TE <br /> k�srto'� ME R FORM <br /> (Note:Some permits may require approval by Building Official and/or Public Works Department) <br /> GENF.,RAI'N-F0R.1VlATION <br /> 1. WATER METERS must be picked up and paid for at City Hall. <br /> 2. IfDossible,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 /> 0 New Meter ❑Additional Meter—For: ❑Replacement Meter <br /> Job bite I DWIler Information, <br /> Site Address: <br /> Owner: Mailing Address: nl <br /> City: Zip: -1� AUVUV <br /> Home Phone: Alternate Phone: l <br /> Contractor IiaformationrNJ A-vx- <br /> �� 6 <br /> C . <br /> Contractor: l '14.0 Contact Person: <br /> Address: " � ��' + 'State License#: PC G q L.y 8\4 <br /> City: "- 1'TZI-�c,aS Zip: Expiration Date: t l-.Z's\,//S <br /> Phone: �} �,—'2 53 d 13 '7 1 Alternate Phone: ( 11- —lam 0 S I <br />