HomeMy WebLinkAboutWater meter info Mar 07 07 07: 40a Tim Iverson 32�-274-8820 p. l
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FOR Cl'fY USE OiVLY
4�� City af Orono
P.O.Bos 66 Duie Recrived� Pemiit#
0�.� � 27501CeIleyParkway
y�1�' C st�!8ay,MN 553Z3 Approved By:(If Requircd):
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�^r��'��o� (952)249�G00
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CI1 Y �F OKONO —WATER MET�R FORM
(*Note:Some pem�its mey require appro��af by thc Duilding Ol�ficial aad/or Public Worlcs Departmeat*)
GENEI2AL�NFORMATION
i. Vi'ATER METERS ntust be pickcd up and paid for at City HaIL
2. lf vossible,fax in this application ahead of time; we will then call you and let yo►►know we have
� The water meter in stock, Fax Number: (952}244-4616. Also,you can eall ahead of tinie to ntake
sare we received the fax,or to�varn us that tlie fax is couung.
3. WATER 1tiIET�ItS must be sef and sealed by Orono Water Departmeret (9�2) 249-�4Gfl0,
upon completion of ineter instailAtion.
; TYPE OF PERMIT
(Check Ail T�at A ly
❑Residential(May Require Approval) ❑ Corrunercial(Approval Requized}
�]Veti� Meter ❑kddYtioriai Meter—For: _ ❑ t�eplacement Metec
( Job Si e /Owner Infonnation�
�
I Site Address: �Z- Rf �
� �r,vner: Mailing Address:
� City: Zip�
�' I-�ame Phoi�e: Alteniate Phor�e:
', Contractor Information: �
I Cont�actor: ��A � Contact Person: / ' �
I �
Addre�s: Z�v'S �C�'iav� _e�� State License#: Z2-I '�
� City. , ��✓�.- Zi�1:�C��/ Expiration Date:
I
PlZone: �/ '"3�3'�Z � Alten�ate Phonc:
Mar 07 �07 07: 4�a Tim Iverson 320-274-8820 p. z
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. � .. . Z007 . ,WAT�R METER PERMI'T F.EES .. : . ::., , `:
� 5/S"�IORN -�244 62 ❑ 3/4"HORN -�249.03 ❑ 1„HOItN -$3�6.00
�
� "WATER 11ZETER ('ft[ESE�YILL Flr\VE TU IIE Sl'LCIAL ORDCRED�PRICES DETk:RV1inED)
� 2�� �
1. METER�'EE: ---
z. xoRrr FE�
� �/S� C� �-
3. TOTAL PERMIT FEE(Add Lines 1-2 Above� �-��--�_
; CTTY-USE ONLY
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I BKANU: ,
SIZ�: (�5/8" ❑ 3/4" ❑ 1'� ❑ OEher „
/ Q� l/ ' ea�� �f-7/.3�
SERIAl.#: �0 �0 �`� ��� r
ERT I�iGH#: _ �������������������� � _. (if applicable)
1810151164
ADDITIONAL INFORMATION-WATER METERS
l he unciersigned'nereby appiies t� the City ofi Orona for issuance of a water meter permit, agrees
to do all tivork i:� strict accordanee:vit?:tl:e e*dinances of the City' and the reou1zt+ons of the St�te
of Minne d certifi that all statements made on this application are, true and eorrect.
�
q �cant: Date: 3'� r�
1
Oriji���nl: 1-�ddress Fife
� Mn�e Copies Far: !- Utilin�Billiug Departn�e�rt /- Gc�slr Dr�rtivcr
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