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METER(S) PElUUT
Date
7--/Y-Yb
Name of Owner ~;;",5r~ ~~ 5 ~
Address of OWner ,/":;- s-: / W;.? h <1 t/j/.?/ r7 r ('" /<
Meter Installed At c:z 5-7,~ Cz? ;,b~ k 7- C/':
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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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V / owner or :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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C."ILLi) (i2J.(fl,j Ii
I Plumbing Inspector