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METER
Date
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Name of Owner l ~")1?i!-A Pc,'-) f) F l700
Address of owne~~ c: wAs/-,;€Uftl\)
Meter Installed At
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Meter(s) Size
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Meter(s) Use
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(Diagram of Use)
Meter will be installed and used according to the above information,
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TO Water Utility: Requirements have been met to purchase and
install meter(s) at the above address for size and use indicated.
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Plumbing Inspe or