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1 At <br /> F R Y USE ONLY <br /> liLW <br /> 0A T City of Orono c Q 1 1, Permit# /3-0//04 .....'"- <br /> * <br /> PO.Box 66 Date Re � e ' <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Approved By:(If Required): <br /> (952)249-4600 <br /> '�t SHO� CITY OF ORONO—WATER METER FORM <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department <br /> *) <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 /> Z'New Meter ❑Additional Meter—For: ❑ Replacement Meter <br /> Job Site/Owner Information: <br /> Site Address: c-) 3 3 1 0 V4.4)-e._ <br /> Owner: Pte. kl-C Mailing Address: 1/7I gy2(hL <br /> 106 <br /> City: ■, c_ i ; Zip: 5 S/aO <br /> I <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: AjKA, Contact Person: a <br /> Address: c a State License#: G 5C13j,/ - PP1 <br /> City: VJv4 4L L. Zip: // Expiration Date: )1-31-X13 <br /> Phone: 763— 753-33 73 Alternate Phone: <br />