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FOI2 CiTY USE ONLY <br /> City of Orono <br /> 4O� P.O.Box 6G Date Received: Pertnit# <br /> ��;, � 2750 Kelley Parkway <br /> a '�j`���'r � Crystal[3ay,MN 55323 Approved By:(If Reyuired): <br /> �+t 1;j��`�iati�G~F (952)249-4(i00 <br /> �AE8Fi�8 <br /> CITY OF ORONO —WATER M�TER FORM <br /> (*Note:Sume permits may require approval by the 13uilding Ot�ticiai and/or Public Works Department*) <br /> GENERAL INFORMATION <br /> 1. WATER METERS must be picked up and paid for at City Hall. <br /> 2. If possible, fax in this application ahead of time; we will then call you and let you know we have <br /> the water meter in stock. Fax Numbei: (952) 249-4616. Also,you can call al�ead of time to make <br /> sure we received tl�e fax,or to watn us that the fax is coming. <br /> 3. WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, <br /> upon completion of ineter installation. <br /> TYPE OF PERMIT <br /> (Check All That Apply) <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> �New Meter ❑Additionai Meter—For: ❑Replacement Meter <br /> Job Site/ Owner Inforn�ation: <br /> Site Address: Z.� �5 ��i1w�ac+ LJ�:,,+y <br /> Owner:�r������i,��-w��;.0 o,�S Mailing Address: <br /> City: (�f D/10 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor lnformation: <br /> Contractor: �rP�i�.ro� ��I�ltc��� h� Contact Person: j'L1/ �-C <br /> Address: �� 1'�a��Pt��l�C.�r(�� State License #: <br /> S"c{i�Fc IQz� <br /> City: `��-, I'►1 ici.-�l Zip:�5�"Il, Expiration Date: <br /> Phon�: �(,�- '{`17 7yb'i� Alternate Phone: U���3� ��%��11;, <br />