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METE:R(S) PERMIT
Date /7),12, 0/?'7j'
Name of
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Owner ~) 1(, ( //i c?
of Owne r $I',,,> S- i4.l .
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Address
Meter ;Installed At /(2 f~7J (~~').1
Meter (S)fize 3/y h
Meter (s) Use ?,-j-:p.J Ie /V:4'f'f;'~h.
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(Diagram of Use)
Meter will be installed and used according to the above
information,
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To Water Utility: Requirements have been met to purchase
and install meter(s) at the above address f9r size and use
indicated.