HomeMy WebLinkAboutWater meter 09/05 2007 12:37 FAX 76� 591 6071 IVERSON 1�001
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� FOR Cl'CY.USE ONLY:.;' . ,
Ci of Orono ``;` ` � �' �
o �' ,pataReceived:' . .Perm��#��=,.
I O�' �� P.O.Box6G , .••". �� � ,.
2750 Kelley Parkway �. , ' '
�'� rt Crys�l Day,MN 553z3 Approvcd By:(If Required); . :i> �.; �
�t,'����d°'� (9S2)249�G00 , .. ' . '
� CIT'Y OF ORONO --'WATE�t 1VI�TER FORM
(*Noce;Some parmits may requiT�aPProval by che 8uilding OfFicial ond/or Public Works Deparlment")
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CrENERAL�TNFORIVIAT.ION : .
I , t. WA,TER METERS must be picked up and paid for at City Hall.
2, If pp$$ible,fax i,n tlus application ahead of tix��e;we will t11en.cal]you and let you l�ow we k�ave
tl�e watrr�eter ui stock. Fax Nuruber: (952)249-4616. A�so,you can call ahead of tinie to ir,ake
staxe we received tl�e fax,or to waxu us that the fax is coming.
3_ WAT�R METERS must be set and seAlcd by Orono VVater Departmc�nt (952) 249-4600,
upan coropletion of ineter installation.
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�'YPE�OF PERM.�T ' �
Che.cic��All That A. 1
❑ Residcntial(May Require Approval) ❑ Commercial(Approval Required)
New Iv�eter ❑Additianal Metez—ror: _ ❑Re�lacement Mcter
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Job Site/Owcler.Yn£orniatioa�: '
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, Site Address: ( a � �`�
Owner: �u��haA ����� Mailing Address:
City: ZiP�
�Iome Phone: Altez7�ate Pl�o��e:
Con1'ractor Information:
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Contractor: n l� �`j Con.tact pezson:
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Address: � 4 � s �� State Licez�se#:
City � � Zip�+� Expiratioz�Date;
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phor_e: � Altexnate Pl�o�le: I�j� 3 63�3 2��p
09/05 2007 12:97 FA$ 769 591 6071 IVERSON �002
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314"M�TER-$291.00 ❑ 1"METER-$356.00
�5/S"METER-$240,00 ❑ ` 1„HORN -$ 73.12
5/8"HORN -$ 44.62 ❑ 3l4 HORN -$ 49.03 ❑
' � r w��i j�MET'ER (TH�SE W1LL HAvE TO�E SpECIAL OMETtED g PR�CES bETERMINED)
. $ • o. �'`7
� 1. METER FEE: _ � _ ,./- �a��s
2. HOItN FE� � ���-��
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3. �'OTA.L PERNIIT�E(Add Lines 1-2 Above)
$ -
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CYTY-USE ONLY
Bx,e,1vD: /V°��2[�t��
SIZE. �/8" ❑ 3l4" ❑ 1" ❑Otllor "
sExz�►�,�: l8 �o��8`5zo
ERT HIG�I#: I��INI I NN II I N INII I 111 (if applicable)
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, �ADDITIONAL�II�IFORiviATION��-WATE�R METER:S �.
The undersigned hereby applies Co the Cxry of Orono for issuance of a wa�er meter pernn,it, agrees
' ta do all wo:k in strict accordance with tt:e ordinances of the City ar_d ttie regulations of the Stace
pf Minnesota,and certi that all statements made on this application arc, true and correct.
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' Date:
Applic
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