HomeMy WebLinkAboutwater meter info FOR CITY USE ONLY
O�D�O City of Orono
P.O.Box 66 Date Received4�oPermit#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(if Required):
(952)249-4600
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 wain us that the fax is coming.
3. WATER METERS must be set and sealed by Orono Water Department (952) 2494600,
upon completion of meter installation.
TYPE OF PERMIT
(Check All That Apply)
Residential(May Require Approval) ❑ Commercial(Approval Required)
XNew Meter ❑Additional Meter—For: ❑Replacement Meter
Job Site/Owner Information:'
Site Address: C,-W-to� � �4-:5 PQ C+
Owner: V �l�G(,�_ ��ii/��j el Mailing Address:
City: , L��G J l b{� Zip: J���
Home Phone: Alternate Phone:
Contractor Information:
Contractor: LAO Nokjj� Contact Person:
Address: ?f 00r✓Iw�t,�-�S {` State License#:
City:, rri 5 Zip: 6 SZ Expiration Date: Z- 3 l - 0 C¢
Phone: b'01-a I Alternate Phone:
❑ 5/8"METER-$240.00 ❑ 3/4"METER-$291.00 "METER-$356.00
❑ 5/8"HORN -$ 44.62 ❑ 3/4"HORN -$ 49.03 1"HORN -$ 73.12
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ ��6 a —�
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �'2 77' 70
CITY-USE ONLY
BRAND: JV 7
SIZE: ❑ 5/8" ❑3/4" 1" ElOther
'7'`1 "
SERIAL#: FS-57 O l a
1111111111111111111111111k
ERT HIGH#: 1810051958 (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 Minnesota nd certifies that all statements made on this application are,true and correct.
Applicant: Date:
Original: 1-Address File
Make Copies For. 1- Utility Billing Department 1- Cash Drawer