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CITY OF OSHKOSH WATER niS1'RlBUtION
WATER METER PERMIT
(please Print)
, Date:
y J-~ />-7
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Meter(s) Installed At: / 0$"'"5'" ~,J j11 tfp,,-'L. "i>/f..'
Name of Owner: /Z"j, 0# 1-!4)<.W
Address of Owner: Po, . 1!x:>J.J 'I Z"3 pJe'!;'!,;> I,wl ;rt11t.3
Meter(s) Size: SA; JI
Meter(s) Use: Check the Use(s) that apply.
Typical New Construction' . .. // . Typical Multi-Unit, Multiple Meter
Single Meter V ......u....vUII
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Typical Deduct Meter
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AU.OWl!Il ......,..,.....
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Typical Water Use Only Meter
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.-nit lIO,A'IiION VALva
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Note:' 1. A Plumbing Permit may be required prior to the installation of the issued water
meter(s).
. 2. All plumbing must be conducted by a Wisconsin Licensed Plumber, except a hQme
owner may perform his/her own plumbing within their single family, owner occupied
home. For inquiries please call 236-5052.
3. Meters 2=. 1-112" require a bypass.
I ~ -.alllGCCIQIIIClLVALVE .
Meter(s) will be inst1dled and used according to the above information.
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Signature of Owner orAgent
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Print Name of Applicant and Company