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METER(S) PERMIT
/100 30. /1%;<
Date
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(-/ JHZV -,=-Jil,/ '/ l71 19- ",.J ,
Name 0 f Owne r L c-:; ...-g t: r:I':
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Address of Owner ' ~
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Meter Installed At / .. ./'
3/7/ If /??: ~e( ;311-.
A "":'7 -~V
/-/;'-/71/ L to)1/l e
Meter(s) Size
O/ve
Meter(s) Use
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/;;;d:: 1-100;2_,
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(Diagram of Use)
Meter will be install~ and
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S,e'9 a:tcot;d:i,.a L) to
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the above information,
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Owner or Agent
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 Inspector