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Name of Owner .fa y: C" i T/e5
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Meter Installed At 1;2 C/O
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Meter(s) Size
Meter (s) Use
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METER(S) PERMIT
Date
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Meter will be installed and used according to the above information,
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To Water Utility: Requirements have been ~et to purchase and
install meter(s) at the above address for size and use indicated.
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('Diagram of Use)
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(J. or Agent
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