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METER(S) PERMIT
Date 7'/~ /rfy
Name of OWner j7x C/l Fe S (;/V S / C /L t2-
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Address of Owner . ~ot.&,/, "S~~ fWt/tL.. ~
Meter Installed At 1,2;2f) ~ d
Meter(s) Size ?/t e.,. /J1o/e / :Z-S--
Meter(s) Use g to lie N.Ar~~.s;, pp/(/
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Meter will be installed and used according to the above information,
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r or Agent
To Water Utility: Requirements have been met to purchase and
install meter(s) at the above address for pize and use indicated.