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6.1. ERMUSR 03-08-2011
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6.1. ERMUSR 03-08-2011
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3/4/2011 4:23:50 PM
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3/4/2011 1:49:03 PM
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City Government
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ERMUSR
date
3/8/2011
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SMART IRRIUATION REBATE <br />~ ' APPLICATION <br />Elk River <br />~- titAIL TO: <br />Municipal Utilitie S ~~ River Munici a1 UtiIities <br />P !t you have questions, <br />C/O SMART IRRIGATION REBATE please ~p 763-441-2020 <br />t3o69 Orono Parkway, P.O. Box 430 <br />Monday -Friday, S:QOAM to 4;30 PM <br />Elk Rig°er, MN 55330 <br />ACCOUNT INFORMATION: <br />NAME ON WATER ACCOUNT:. <br />ACCOUNT #: <br />ACCOUNT HOLDER PHONE #: <br />APPLICANT INFORMATION: <br />Name of person applying Email <br />Day Phone: <br />Cell Phone <br />E~rening <br />Mailing Address: <br />IRRIGATION INFORMATION: <br />Property Type (circle one): Single Family Association/Multi-family Commercial <br />Irrigation System Installation Year: <br />INSTALLATION COMPANY: <br />INSTALLER PHONE #: <br />INSTALLER NAME: <br />SMART CONTROLLER INSTALLATION DATE: <br />SMART CONTROLLER BRAND: <br />SMART CONTROLLER MODEL NAME or NUMBER: <br />NUMBER OF IRRIGATION ZONES: <br />YOUR SIGNATURE (required): <br />Signature: Date: <br />(OFFICE USE ONLY) <br />REBATE VERIFICATION: Irrigation Use History (past 3 years): Year z Year 2 Year 3 <br />Inspection Date: _ Time: Inspector: <br />
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