HomeMy WebLinkAboutwater meter info � , - t
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FOR CITY USE:ONLY
O,¢��,0 City of Orono �i'
P.O.Box 66 Date Receive�,��d����CPermi##
2750 Kelley Parkway
� t. ,M1 � Crystal Bay,MN 55323 Appraved By:(If Required):
° " (952)249-4600
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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 possible,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 PERMTT
Check All That A 1
❑Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: Replacement Meter
7ob Site/Owner Information:
Site Address: a�C�r'J J�' FI�A DYUIV O.V i'�.,V �R�N�, �11� 55 331
Owner: L1JdIV /yl/4'R.fE FU)( Mailing Address: 15A'1'�'iF�
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c�ty: �FZ�N� z�p: �53�I
Home Phone: ��{� �7�-- ��rDg Alternate Phone:
Contractor Information:
Contractor: i.UE[�D dr SON� Contact Person: ('ViftklC U�1/1�
Address: 3'f I n K+L!►��R LN I�J State License#:
c�ty: P�y mo u�� Zip: ��� Expiration Date:
Phone: �l���t�1.�j'�Qo�q�j Alternate Phone:
� , 1
/8"METER- � � 1 LI� ❑ 3/4"METER- ❑ 1"METER-
5/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ �/ �• �
2. HORN FEE $ �� - �
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �L l. �
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
B�rr�: �_P_n-�Y�-��
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SIZE: �5/8" ❑ 3/4" ❑ 1" ❑Other "
SERIAL#: g O� D 7�g�
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ERT HIGH#: ���� (if applicable)
ADDITIONAL 1NFORMATION-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 Minnesota, and certifies that all statements made on this application are, true and correct.
Applicant: �� Date: �CJ �� �
Original.• 1-Address File
Make Copies For: 1- Utility Billing Department 1- Cash Drawer