HomeMy WebLinkAbout2008 - Water meter sale � FOR CITY USF,ONLY
,���� City of Orono �
P.O.Box 66 Date Received: Permit#
�"� � 2750 Kelle Parkwa
� Y Y
� ��'�'�,�.'�. � Crystal Bay,MN 55323 Approved By:(If Required):
t� ��r��,�o (952)249-4600
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CITY OF ORONO —WATER METER FORM
(*Note:Some permits may require approval by the k3uilding 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 rime; 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 PERMIT
(Check All That Apply)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—Far: ❑ Replacement Meter
Job Site/Owner Information:
Site Address: ���}�-' �tz�c� ��• ('�-�.
Owner: v�,,�ce.���<,� �UN Mailing Address:
City: blQn 1� Zip:
Home Phone: Alternate Phone:
Contractar Information:
Contractor: tJ� N/���t I�L�µ�,n��:� Contact Person: i�;� ,��,;,,; (
Address: 43ac� C��r��-k State License#: �
City: ��"--�5 Zip: Expiration Date:
Phone: �.1r/— 7�S '7bsy Alternate Phone:
!
� �� � WATER METER PERMIT FEES ������ ���
'"WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- ❑ 3/4"METER- "METER-
❑ 5/8"HORN - ❑ 3/4"HORN - 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ � O �- / �
2. HORN FEE $ 9 �` G�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ � � 7� �U
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
B�ND: �) f�� �l -Q
SIZE: ❑ 5/8" ❑ 3/4" �' ❑ Other "
III III IIII I II I IIIII II II III III
SERIAL#: .� /� ��o�Lj v 1810233978
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, a certifies that all statements made 's plication are, true and correct.
Applicant: Date: �—Zv `� �
Original: 1-Address File
Make Copies For: 1- Utility Billing Department /- Cash Drawer