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CIT;V',:OF:OSHKOSHWATER DISTRIBUTION
W ATERMETER PERMIT
(please Print)
Date:
~-'3/-()()
Meter(s) Installed At: 1 L r
Name of Owner: F.t'fU ~
Address of Owner: !5t:l-W\.t:.
Meter(s) Size: 3;;, t..t
Meter(s) Use: Check the Use(s) that apply.
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Typical New Construction
Single Meter
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Typical Multi-Unit, Multiple Meter
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Typical Deduct Meter
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Typical Water Use Only Meter
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Note: I. A Plumbing Permit maybe required' prior to the.insta1lationof the issued water
meter(s).
2. All plumbing must be conducted by a Wisconsin Licensed Plumber, except a home
owner may perform his/her own plumbing within their single family, owner occupied
home. For inquiries please call 236-5052.
3. Meters ~ 1-112" require a bypass.
Meter( s) will be insUrlled and used according to the above information.
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Signature of Owner or Agent Print Name of AppHC8nt and Company