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CITY OF OSHKOSH WATER DISTRIBUtION
WATER ME'TER PERMIT
(please Print)
, Date: / - ~}., c 3
Meter(s) Installed At: :5 22 A Pv d:sop'; .5 +
Name of Owner: <c.' /-z-er S / ~';';:J
Address of Owner: . Po Be 1" }?,,,Ls"- r) ,<:: A yc....$ /.. w _r:. .s~4' 9',: /
Meter(s) Size: . :k"'
Meter(s) Use: Check the Use(s) that apply.
Typical New Construction
Single Meter
. Typical Multi-Unit, Multiple Meter
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Typical Deduct Meter
NO UMlrIll't
.......DI8CIU... 1U.Illd VMR",
M.I.DW'm -....,_
Typical Water Use Only Meter
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NO UIn'..,
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Note: ' I. A Plumbing Pennit 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 perfonn hislher own plumbing within their single family, owner occupied
home., For inquiries please call 236-5052.
3. Meters::: 1-1/2" require a bypass.
I ~ __CCIImIClIL VA&.l/E .
Meter(s) will be insudled and used according to the above infonnation.
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Signature of ~er or Agent Print Name of Applicant and Company