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METER(S) PERMIT
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Date,
Address of Owner
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Name of Owner
Meter Installed At /3 6J
Meteds) Size f4 JltA
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Meter(s) Use
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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 m~t to purchase and
install meter(s) at the above address for s~ze and use indicated.
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Plumbing Inspector
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