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ADDRESS { j b ru i~ J ,'l ,m
OLD ADDRESS
ZONE
DATE TYPE
NATURE OF WORK
OWNER
CONTRACTOR
VALUATION
METER(S) PERMIT
Date /01,- a- 7i
Name of Owner `s x" 6i ,• is -/ t
Address of Owner ° Gv. 5. 4i -ffi
Meter Installed At A2.0 .0 r d c,Ay r i ,
Meter (s) Size V 4e t i.d � /
Meter (s) Use 4
ot. 4 p
7 a4 Ad .catrw-i-7.-
114
r ocg. _ rte _ __ 4
• f�
/91
(Diagram(Diagram of Use)
Meter will be installed and used according to the above
information,
/4:-i,:.,— , 00 if -
• er or Agent
To Water Utility: Requirements have been met to purchase
and install meter (s) at the above address for size and use
indicated. ILA \c--X( (./,t/I -Y). ,,°_,:)( At 'II
, Li! '-')
/ plumbing IOspector