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METER (S ) PERMIT
Date
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Name of OWner
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Address of OWner
Meter Installed At ) / (! \;-' ... 1../") (J?C /1 ,,:; /( <:) ('" "j'
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Meter(s) Size 3(,( t rh 00 r:;; (. 11;) :;--
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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OWne r or Agent
To Water Utility: Requirements have been met to purchase and
install meter(s} at the above address for size and use indicated.