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� � (�/ FOR CLTY USE ONLY
,�` City of Orono ` �
'�y�'O`Y p.p.gox G6 �� Date Received: Permit#
�` � 2750 Kellcy Parkway �
�,�� A roved B If Re uired
a �Il�'�,�,r�',- �',' Crystal Bay,MN 55323 PP Y�� 9 )�
�v �;�'�,.,��.'i�o o (952)249-4600
�lit'.i�>�$6
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CITY OF ORONO -WATER METER FORM
(*Note:Sume permits may require approval by the I3uilding Otficial 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 call you and let you know we have
the water meter in stock. Fax Numbei: (952) 249-4616. Also,you can call allead oF time to�nake
sure we received the fax,or to wain us that the fax is coming.
3. WATER METERS ►nust be set and sealed by Orono ��'ater Department (952) 249-4600,
upon comptetion of ineter installation.
TYPE OF PERMIT
(Check All That Apply)
[�Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑Replacement Meter
Job Site/ Owner Information:
Site Address: ,�� �����-� �� � � l�� � � � ���� �r'`' �„���
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Owner: ��� � �` i� '� ��' l-'t C i�6�� / �' Mailing Address:
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City: f l _ ��`° t �.:oc:�,t �/ Zip: � �_zz ,� --% -� r �
c�.y�� �>
�Iome Phone: ��C a� �� � �/=�(^'(� Altei-�iate Phone:
Contractor Information: I
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Contractor: �c�!��<<�� �� �< < <�"�� � � �on�act��erson:
Address: � �' � ���% ��� ��� J�'/State License #:
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City: ��� �l �r�'� Zip:SS�����Expiration Date:
Phone: ��� � ��7� - �J����� Alternate Phone:
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2007 - WATER METER PERMIT FEES
��t�,L i'��" � � ? '
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❑ 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"HOIZN -$ 73.12
� "WATER METER (TEIESE WILL HAVE TO BF,SPECIAL 0[iDERED&NKICES UETER�71\ED)
,
1. MBTER FEE: $
�.-��- L� . c
2. HORN FEE $ �3 , �a
3. TOTAL PE1tM11'FEE(Add Lines 1-2 Above) $ ��� `,� - �'�
' ��cC'Ct2E�<i�2
�- �ij C� . � L'
._� j �-7Cy /�
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CITY-USE ONLY
BRAND: 1�12��U�'\<..
SIZ�: ❑ 5/8" ❑ 3/4" (�1" ❑ Other "
SERIAL#: �, ��k`��'� 4� ( y
ERT HIGH#: IIIIIIIIIIIIIII IIIIII III IIII�
1810048866 (if applicable)
ADDITIONAL 1NFORMATION—WATER METERS
1 iie unciersigned nereny appiies to ihe �ity oi vrot�o ior issuaiice oi a water iilctEi�i21ii71i, a��eS
�o do al; w;,rk ir. st;ict accordance vrith t�ie e:�?inances �f the rity a�-!d the regulations of the State
of Minnesota, and certifies that all statements made on this application are, true and coirect.
Applicant: l� Date: I ! �
Orrginal: 1-A�Iclress File
Mczke Copies For: !- Utiliry Billiiig Department I- Cash Drawer
Dee-2�06. 11:24am From-CITY OF ORONO +9522494616 T-131 P.001/001 F-691
�'
(Updated OS/15/06)
CT'�Y O�' QRONO SAL� OF WA'X'ER ME'xER
Box 66 (2750 Kelley Parkway)
Crystal Bay,MN SS323
` ��
GEN�RAL TNFORMATION �V/
,/
1, Water rnetez's must be picked up and paid for at City Hall,
2. Water metcrs must be sct and sea�ed by Orono'V�'ater Department(952-249-4600)upon
completion o£meter installntion.
JOB SITE ADDR�SS: 'Q- '� �
� Residential � CommerCial
Occupancy Type; ,�� ----�
�wner'sName:.��i/�--�� �`'��n-��-�---
Pho�/Number:
Mailin Address: o�- i.c� � "'�7'' � �'`�`�" �' S�
g �� �
,���-,� i
Cantractor's Narne:� ,(���=���bone Number:_ �ISa- �7��' %2-�
MRiting Address: 7.�S < a.�....���1.��1 Of }� C1CY= �p'S�`3�'
1�
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I�(�TER�1�F+�R�M�TI�1�1
(5/S" meters =$210.00; 3/4" meters = $Z50.00� 1"meters =$320.00)
Serial Nurnber: �� ��� High -
' i�
Size:�l� �� �� Brand: V��� `�(, ype:
Merer 1�'ee; $
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Sigrzature of Applicant: �/ � ���'' Date: ' �G(�.(o
Make Cop�es For: 1-AddTess File l-Ucility Billing Depc l,Cash Regis�er
v;�(Porrns)�W aLermeter Sole Form•w�d
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