HomeMy WebLinkAboutwater meter FOI2 CiTY USE ONLY
City of Orono
4O� P.O.Box 6G Date Received: Pertnit#
��;, � 2750 Kelley Parkway
a '�j`���'r � Crystal[3ay,MN 55323 Approved By:(If Reyuired):
�+t 1;j��`�iati�G~F (952)249-4(i00
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CITY OF ORONO —WATER M�TER FORM
(*Note:Sume permits may require approval by the 13uilding Ot�ticiai 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 al�ead of time to make
sure we received tl�e fax,or to watn 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 ❑Additionai Meter—For: ❑Replacement Meter
Job Site/ Owner Inforn�ation:
Site Address: Z.� �5 ��i1w�ac+ LJ�:,,+y
Owner:�r������i,��-w��;.0 o,�S Mailing Address:
City: (�f D/10 Zip:
Home Phone: Alternate Phone:
Contractor lnformation:
Contractor: �rP�i�.ro� ��I�ltc��� h� Contact Person: j'L1/ �-C
Address: �� 1'�a��Pt��l�C.�r(�� State License #:
S"c{i�Fc IQz�
City: `��-, I'►1 ici.-�l Zip:�5�"Il, Expiration Date:
Phon�: �(,�- '{`17 7yb'i� Alternate Phone: U���3� ��%��11;,
'2007 -WATER METER PERMIT FEES
❑ 518"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 ORDEREll&PRICES DETERMINED)
1. METER FEE: $
2. HORN FEE $
3. TOTAL PEf2MIT FEE(Add Lines 1-2 Above) $ G�,��"� ��
CITY-USE ONLY
BRAND: ��� i_�-fi� '� 1 �C� �. C_UC�,I?i'�
SIZ�: ❑ 5/S" ❑ 3/4" �1" ❑ Other "
SERIAL#: ! �j � � , �i� :�.-,? t_�
iuuuu�iuiniuiuuiiui iuuuiuiu�niuiuiauii (ifapplicable)
ERT HIGH#: _iasoszzszo (HI) - �46062262� ��ot
ADDITIONAL INFORMATION—WATER METERS
l iie unciersigned'nereny appiies to the City �f vrui�u ior issualice oi a water r�ieter�;eL-mit, a�-:,es
i0 uv flll WOiiC;i. SiT.�� �CCOYuu11CC Wltr;�}le C:�1T:ar.cPs of the Ci±;� �??d±he reaulati�ns of the State
of Minnesota, an certifies that all statements made on this application are,true and correct.
Applicant: � Date: �" .��d�
Original: 1-A�Idress File
Make Copzes For: 1- Utilr.ry Bi]lirtgDepar•tnient I- C«sh Drarver