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METER(S) PERMIT
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Date 0 - 0 - 00
Name of Owner /I/L5; /hJ . /00c/-c
Address of Owner
Meter Installed At / g 5- <;- Orc.r/.4/i'/.:J r:4/v~
Meter (s) Size ~A' <, -Z:E ;?'S-
Meter(s) Use
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(Di~gram of Use)
Meter will be installed and used according to ,the above
information, . ' . ,
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' OWner ~r ~gent
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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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~,' ~ n9 Inspector
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