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FOR CITY USE ONLY
/' 0�` City of Orono
// ¢ `�` P.O.Box 66 Date Received: Permit�f
���'4 � il 2750 Kelley Parkway
n- Crystal Bay,MN 55323 Approved By:(If Required):
��rp:,�.p�% (952)249-4600
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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 cali 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 A 1
.�Residential(May Require Approval) �Commereial(Approval Reyuired)
�New Meter ❑Additional Meter—For: �Replacement Meter
Job Site/Owner Information:
Site Address: ���,�j 'Q� L ��r-,� ��-
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Q�jj���4�,�t�pz�-r�� Contact Person: :�`j���1��,�SC �
Address: �f�,� 7(�1�h�-1 �l;�v State License#: � ����`Q�(Q��
City: 2;rYwr.�,rvr�,,� Zip:Yl'lY� Expiration Date: �UC_ ��� �C?�`=�
Phone: ��3""��Sl�-�5� Alternate Phone:
. ,, .
2007-WATER METER PERMIT FEES
5/8"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
� "WATER METER (THESE WILL HAVE TO BE SPECIAL OItDERED&PRICES DETERMINED)
1. METER FEE: $ a��
2. HORN FEE $ l.�V� LQ�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $"`�'�� , �p�
CITY-USE ONLY
BRAND: �v�`�� 'e-
SIZE: �5/8" ❑3/4" � 1" ❑Other "
SERIAL#: S/ 9 0? �U c� �
Ilfll 11 I111 III 111111111111111
ERT HIGH#: _�asoez�i4o ���� (ifapplicable)
IIIII II ill I II11II I IIII I IIII 11
�45062714� (LO)
h��_____ .__� 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 or 'nances of the City and the regulations of the State
of Minnesota, and certifies t��ll s te made on this application are,true and correct.
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Applica� Date:
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Reset Form
Original: 1-Address File
Make Copies For.• 1- Utility Billing Depariment 1-Cash Drawer