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CITY OF OSHKOSH WATER DISTRIBUTION
WATER METER PERMIT
(PIf:ue Prmt)
D1AU:M 11o~.
Mmr(s) Imtalled M:____ ..Z7l-l ~(I/>>...... sT ..".
Name ofOwuer. -.. ~~. ~ -- , :
Address o~ Owur. - ~. ".-.(!. 0/ p ;;.; .bg'/VI
Meta'(s) SIZe: ~( "'-'. y
Meter(s) USf!: Checktbe U e(s} that apply.
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Single Mew ~
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Typical 'Multi-Unit, Multiple Meter
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Typical Deduct Meter
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Typical Water Use Only Meter ,
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Note: 1. A Plumbing Permit ma.y be required prior to the installatiOn of the issued water
merer(s).
2. All plumbing must be: con.ducted by a Wisconsin Licensed Plumber. e.xcept a home
ownc:1' may pcrfunn hislher oWn plumbing within their sIngle family, owner occupied
hOlI1c. For inquiries please: call 236-:5052.
3. Me+.ers 2': 1-112" require a bypass.
Meter(s) will be insta'lled and used according to the above infonna.tion.
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. . Signature of Owner or Agent
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Prim Name of Applicant:md Com.pany 17~P1b~ ~
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