HomeMy WebLinkAboutwater meter info ' FOR CITY USE ONLY (,'
City of Orono /�F�
O4�'�� P.O.Box 66 Date Received: Permit#�
q'�s,�� 2750 Kelley Parkway 2007
� �y ,'�.� Crystal Bay,MN 55323 Approved By:(If Requ�red):
` (952)249-4600 G)=
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CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
GENERAL INFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If nossible,fax in this application ahead of time;we will then call you and let you know we have
the water meter in stock. Fax Number: (952)249-4616. Also,you can call ahead of time to make
sure we received the fax,or to warn us that the fax is coming.
3. WATER METERS must be set and sealed by Orono Water Department (952) 249-4600,
upon completion of ineter installation.
TYPE OF PERMIT' '
Check All That-A 1
,�Residential(May Require Approval) ❑Commercial(Approval Required)
(�New Meter ❑Additional Meter–For: ❑Replacement Meter
I
7ob Site/Owner Information: ,
Site Address: 1X�2 \ S�j`�
Owner: 2G�C�fi(l�,�/_`�� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: �SP-,� (�/(,,,h„��� Contact Person: � \1N-� �—v�PJ��o�
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Address: �11����I l� State License#: 22l '�
City: Zip9��� Expiration Date: �'�c 3� �7
Phone: Alternate Phone: �/l l�-��� 3 Z7�f�
� I
z °� � F `��a2007 �'V�`�mER NTE`�E�PER1VI.�T':FEE�� � `
� 8"METER-$240.00 ❑ 3/4"METER-$291.00 ❑ 1"METER-$356.00
� ' /8"HORN -$ 44.62 ❑ 3/4"HORN -$ 49.03 ❑ 1"HORN -$ 73.12
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL 0[iDERED&PRICES DETERMINED)
1. METER FEE: $ � �G ' ���
2. HORN FEE $ y�• ��-
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �l�`� , �i�t�
CITY—USE ONLY
Bxart�: ��/�'��u��.__�
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SIZE: i� 5/8" ❑ 3/4" ❑ 1" ❑Other "
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SERIAL#: �l/��7� �'
ERT HIGH#: (if applicable)
ADDITIONAL INFORMATION—WATER METERS `
The undersigned hereby applies to the City of Orono for issuance of a water meter permit, agrees
to do all work in strict accordance with the ordinances of the City and the regulations of the State
of Minnesot certifes that all statements made on this application are,true and correct.
Applicant: Date: � — —
Origiraal: 1-Address File
Make Copies Fo�-: 1- Utility Bi1li�igDepar•tment 1- Cas1t Drawer