HomeMy WebLinkAboutwater meter form-2007 FOR CITY USE ONLY
,�` City of Orono
4O`V P.O.Box 66 Date Received: Permit# _
��,�,,� � 2750 Kelley Parkway
' �Il�'�"`� �' Crystal Bay,MN�5323 Approved By:(If Required):
� ��'��r�$�o` (952)249-4600
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CITY OF ORONO —WATER M�TER FORM
(*hote:Some permits may require approval by the Buildino Official and/or Public Works Department*)
GENERAL INFORMATION �
1. WATER METERS must be picked up and paid for at City Hall.
2. If Uossible, 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: (9�2) 249-4616. Also, you can call ahead of time to make
sure we received the fax, or to warn us that the fax is conung.
3. WATER NTETERS must be set and sealed by Orono Water Depa��tment (952) 249-4600,
upon completion of ineter installation.
TYPE UF PERMIT
(Check All That Apply)
Residential(May Require Approval) ❑ Commercial(Approval Required)
�ew Meter ❑ Additional Meter—For: [�Replacement Meter
Job Site/ Owner Information:
( � � � � �
Site Address: `J � � — Q �
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Owner: �t��f ��'�� Mailing Address: � �Q��� �L"'�-
��City: Zip: �� �
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Home Phone: ���� �' ��� Altenlate Phone: �/� ����`���
Contractor Information:
c._ �.� � �� �C r C��,,�
Contractor: ��� Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
2007 - WATER METER PERMIT FEES
�/8"METER-$240.00 ❑ 3/4"METER-$291.00 ❑ 1"METER- $356.00
❑ 5/8"HORN -$ 44.62/�' ❑ 3/4"HORN - $ 49.03 ❑ 1"HORN -$ 73.12
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"WATER IV�TER (THESE WILL HAVE TO BF.SPECIAL ORDERED&PR[CES DETER:�it\ED)
1. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $
CITY-USE ONLY
1 1
B�rr�: �v ���-t�- i'�-��
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SIZE: 5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#:
`�l � ,r� � ��-, �� C�
IIIII II III I III 111111 I 11 III 111
ERT HIGH#: 14Gp�Z104e �►+i� (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned'nereby a lies to the City of Orono for issuance oi a water meter pe�it, agrees
to do all wcrk in str:ct a�c :d r.,,e v� h the o dinar.�es of thP City and the regulat;o„S nf the State
of Minnesota, and certk� s t�t al teme �made on this application are, true and correct.
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licant: ''f Date: �
App V
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