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CI'T'Y USE ONLY <br /> O�T City of Orono <br /> VW <br /> / P.O.Box 66 Date Received:o?-0224I Wit#���-Q�� <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 BY:( Required):(952)249-4600 <br /> kEo� CITY OF ORONO—WATER METER FORM <br /> SH (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 /> 0 Residential(May Require Approval) 0 Commercial(Approval Re fired) <br /> ❑ New Meter 0 Additional Meter—For: Replacement Meter <br /> Job Site/Owner Formation: <br /> Site Address: I Z 0 Fp E -;IJp S S p.c_____yD <br /> Owner: J7,L) u-AA Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: //16 PI VM 6(Ai/contact Person: A G,i -Ai <br /> Address: i I U 7 37�„� G ,r State License#: iC40 7v� <br /> City: '(,4(/(/! Zip: ri A) Expiration Date: 12// <br /> Phone: 7(3 r'Z Z 6 Alternate Phone: 7i 5'"33 1- z Zoe <br /> 1 -1-6 ‹ <br />