HomeMy WebLinkAbout2007 - water meter form J
FOR CITY USE ONLY
' City of Orono
2750 Kelley Parkway
/o 4 `���� P.O.Box 66 Date Received: Permit#
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t'>�r Crystal Bay,MN 55323 Approved By:(If Required):
_. ,}9 j% (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 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 meter installation.
TYPE OF PERMIT
(Check All That Apply)
ildResidential(May Require Approval) ®Commercial(Approval Required)
IS/New Meter ❑Additional Meter—For: El1 Replacement Meter
Job Site/Owner Information:
Site Address: n 0 �j f/l o W OC
Owner:II 11\i.I) 013or.) Mailing Address: 5cl Yom.
City: La(19/--4 k E Zip: SS 3 S
Home Phone: %5)-1-17 Lid.S 9 Alternate Phone:
Contractor Information:
Contractor:C.,14-YO e v`1 1)1 15 -43 Contact Person: ( u:4 h G:&rf jCv\✓
Address: I'60 B Wes+ Wayz4`64?JC State License#: 4/10-M
City: L£wl) k e- Zip:55356 Expiration Date: 13(4-7
Phone: /Sa4-t7 3171.3 Alternate Phone: 6/,)- 8S S
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2007 - WATER METER PERMIT FEES
❑ 5/8"METER-$240.00 (°, "3/4"METER-$291.00 ❑ 1"METER-$356.00
0 5/8"HORN -$ 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: $ ? /�• ��
2. HORN FEE $ 9 �•&3
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) *Calculates $ 0 00 2 Q�
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CITY-USE ONLY
BRAND: /(4e-7-)t //
SIZE: ®5/8" `51'/4" ❑ 1" ❑Other
SERIAL#: 5/05
ERT HIGH#: / S' 0 ' t6 * (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,and certifies that all s .tern; is made on this application are,true and correct.
�-- 1 0/34:)C
Applicant
Date:
Reset Form
Original: 1-Address File
Make Copies For: I- Utility Billing Department 1-Cash Drawer