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FOR CITY USE ONLY
,9,c)4. City of Orono
O
P.O.Box 66 Date Received: Permit#
,...F 2750 Kelley Parkway
• Crystal Bay,MN 55323 Approved By:(If Required):
(952)249-4600
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 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 meter installation.
TYPE OF PERMIT
(Check All That Apply)
Residential(May Require Approval) ®Commercial(Approval Required)
jNew Meter ❑Additional Meter—For: ®Replacement Meter
Job Site/Owner Information:
Site Address: Lf 01'-1 IJ9✓ . jl re f�r(V
Owner: Fired-JDkVA Mailing Address: CJS Vat LW
city: M(Avn,6y"s4- Zip: SG5b
Home Phone: 70-2)-1'33- SD6-0 Alternate Phone: (0(2--)01-514
Contractor Information:
Contractor: 1 th' .l9I 66I--i J -6115 Iitact Person:
Address: Zip S W Pin 6 ) State License#: •t� • �'
City: h^ti Zip:_gZjet Expiration Date:
Phone: '1�2- tiq 141 Alternate Phone: `15?---2-(51)_ -
a i
2007-WATER METER PERMIT FEES
❑ 5/8"METER-$240.00 ® 3/4"METER-$291.00 Ei 1"METER-$356.00
❑ 5/8"HORN -$ 44.62 0 3/4"HORN -$ 49.03 1"HORN -$ 73.12
"WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ V 55k0 0
2. HORN FEE $ 73 . 1 2--
3.
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ "Crqz . 1 2
CITY-USE ONLY
BRAND: /Ueplu4 �-
SIZE: ®5/8" / ❑3/4" p1(1" ❑Other
SERIAL#: 7
111011 III IIIIIII I11I111I011 01011111I111111111111111111
ERT HIGH#: _1460616856 (HI) 1460616857 (LO) (if applicable)
ADDITIONAL 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 ordinances of the City and the regulations of the State
of Minnesota,and certifies that all statements made on this application are,true and correct.
Applicant: N.`, Date: ZI Z(C 6 o)
Reset Form
Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer