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69/66/2602 10:56 1-920-730-0898
HANSONS QUALITY PLUM
PAGE 01/01.
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CITY OF OSBKOSHWATERDIS~~ I!Y~^
, . WATER METER PERMIT ~4fO:~~,ph 0 <'tJ~ <.J
(Plaae Priat) , 'Iii- a '4t('4tr
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Meter($) Installed At: .:)1"l'1. \-"e~ ,\\ \nn $:J .
NaDlc of Owner. c..c \:-i
Addnss of Oner. ta1l vet f' A-~
Meter(s) Size: '1<-1
Meter(s) Use: Cheek the Usc(s) that apply.
Date: <(-fa -0 'Z
Typical New Construction >(
Single Meter .
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Typical Deduct Meter
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Typical.Mu1ti~U~ Multiple Meter
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Typical Water Use Only Meter
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Note; 1. A Plumbing Pennit may be required prior to the installation of the issued water
meter(s).
2. Allplum.bing must be conducted by a W1!Consin Lieenseo Plumber, except a home .
owner may perform bislber own plumbing within their single family. OWIlet' occupied
home. For inquiries please call 236.5052.
~. Meters ~ 1-1/2" require a bypass.
Meter(s) will be insta:Ued and used aa:ording to the above information. .
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Signaiure of Owner or Agent Print Name of Applicant and. Company v
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