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METER(S) PERMIT
Date
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Name of OWner 055"'1 Z
Address of Owner
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Meter Installed
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Meter(s) Size
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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Agent
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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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I ,Plumbing I sp ctor
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