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From:7634974263 08/04/2015 10:27 #860 P.001 /002 <br /> R TY USE ONLY / <br /> �O'V City of Orono <br /> P.O.Box 66 Date Receiv Permit# <br /> O 2750 Kelley Parkway 45-7l4� <br /> Crystal Bay,MN 55323 Approved$y:(If Required): <br /> (952)249-4600 <br /> y���Kf o�x G� CITY OF ORONO—WATER METER FORM <br /> S H (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 /> [ New Meter ❑Additional Meter—For: ❑Replacement Meter <br /> Job Site/Owner Information: <br /> Site Address: dq Q6 61, 6ear_n 20#4D <br /> Owner: 4,-k Mailing Address: ':SAMr'. <br /> City: (, rta Zip: 5 32 3 <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: ��1140&,,tN l�rC'. Contact Person: &4-14L rt1✓\1 <br /> Address: 41q.5 to 2t( vr-- State License#: JrCIt Z$7 <br /> City: -.5,4-YA1=�C� Zip: 7 xpiration Date: 1z 31 1-5— <br /> Phone: 1o3) y?7- ZZgO Alternate Phone: ((olZ) 3gp '�3zy <br />