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METER (S) PERMIT
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Name of OWner
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Address of OWner
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Meter Installed At
Meter(s) Size 'j{;'
Meter (s ) Use f ) IV /TI"<l r.'Y
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tDiaqram of Use)
Meter will be installed and used accordinq to the above information,
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OWne r or Aqent
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 Plumbinq Inspector"'"