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Document G <br />Elk ~~~ .. ~. L ~®; <br />M 1 LJ~li~i <br />~~~lL~~~~°~~I~T <br />~~~~p~ ~s <br />)FIk )Raver IVdeaxaicipal ~Jdalai~~s If you have questions, <br />/O SMART IRRIGATI01`I REBATE please call 763-4~ 1-2020 <br />13069 Orono Parkway. P.O. Box 430 <br />Monday -Fnday, 8:OOAM to 4:30 PM <br />Elk River, MN 55330 <br />ACCOUNT INFORMATION: <br />NAME ON WATER ACCOUNT: <br />ACCOUNT #: <br />ACCOUNT HOLDER PHONE #: <br />AIPFLICANT INFORMATION: <br />Name of person applying Emai <br />Day Phone: <br />Evening Phone: <br />Mailing Address: <br />Cell <br />IRRIGATION INFORMATION: <br />Property Type (circle one): Single Family Association/Multi-family Commercial <br />Irrigation System Installation Year: <br />INSTALLER PERSON/COMPANY: INSTALLER PHONE #: <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: <br />Inspection Date: <br />Time: Inspector: <br /> <br />