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CITY OF OSHKOSH WATER DISTRIBUtION
WATER ME'TER PERMIT
(please PriDt)
. Date: I 2 / / 3 / 0' .c
'Meter(s) Installed At: '3 c:6 C- t / LA- c ~
Name of Owner: 7) ~ tv ,"- !- He J.1 I~;
Address of Owner:, . _ q~ I ~ (~l?C l-I sT.) 0':> J+ !lv~ JJ,. U J/ . -::;;: LJ o;c I
Meter(s) Size: '3/..t.i i,' . . -
Meter(s) Use: Check the Use(s) that apply.
Typical New Construction
Single Meter v
. Typical Multi-Unit, Multiple Meter
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Typical Deduct Meter
110 UIIlfIll'f
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Typical Water Use Only Meter
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Note:' 1. A Plumbing Permit may be required prior to the installation of the issued water
meter(s).
. 2. All plumbing must be conducted by a Wisconsin Licensed Plumber, except a hQme
owner may perform hislher own plumbing within their single family, owner occupied
home. For inquiries please call 236-5052.
3. Meters~ 1-112" require a bypass.
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Meter(s) will be insudled and used according to the above information.
~ ~ 6-128"6-
Signature of Owner or Agent'
!f.C/-rJ'1//.Jr Pd-S f'LI3 0,
Print Name of Applicant and Company