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08/17/2015 11 :57 #3778 P. 001/002 <br /> • <br /> C/e $ti <br /> Cityof Urono R CI y US':ONLY = 3 ��.,7 f,. C <br /> �`°'V0 P.O.l5ox 66 Date Ricer yEll /S Permit ii p30/.J— t <br /> 2750 Kelley Parkway <br /> w <br /> Crystal Bay,MN SS323 Approved By""'Required): 7 / 8// V5I <br /> (952)249-4600 <` <br /> l'I <br /> l�Krsrto�� CITY OF ORONO—WATER METER FORM LW'S°I Ti IS I IS <br /> _�---• (Note:Some permits may require approval by the Building Official and/or Public Works Department) <br /> GENERAL INFORMATION 4 ltd <br /> 11 <br /> 1. WATER METERS must be picked up and paid for at City Hall, / 6 �l' /3 2 J <br /> 2. If possible,fax in this application ahead of time;we will then call you and let /ttIL" <br /> the water meter in stock. Fax Number:(952)249-4616. Also,you can call ahe 70, , p2J <br /> sure we received the fax,or to warn us that the fax is corning. <br /> 3. WATER METERS must be set and sealed by Orono Water Aepartm / Q //� [7/ <br /> upon completion of meter installation. // o / ` <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> 0 Residential(May Require Approval) Commercial(Approval Required) <br /> rtiNew Meter 16 Additional Meter—For: r( r.54 4, 0 Replacement Meter <br /> Job Site/Owner Information: <br /> Site Address: 11Otc e ryrN grate RA 14 <br /> J <br /> Owner: 4+.04 Tv...ea.% Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information_ <br /> Contractor: f`d ci4n mktwn t eaI Contact Person: 'Sa i n 442 yA sa,mi <br /> ecR GK ivcs <br /> Address: E 9 7c ateo- 2ec State License#: pc 6,4 -i&-s <br /> City: ae...1o..w. Zip:`6 ag.Expiration Date: i-2-- t,i- <br /> Phone: I- ' 1 7 1 - d-17,1-- Alternate Phone: ' = ‘?—t-g/Ia <br /> \I_ -acne eft �v\ rad F«6^6,+r <br />