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CITY OF OSHKOSH WATER DIST~ttt!~\;:
WATER METER PERMIT /
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(please Print)
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Date:
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.COMMUNITY DE\T! r;:~' r....
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Meter(s) Installed At: .5:.$ 0 (.) ;-1 Q r hDT .g G.. '! R D
Name of Owner: j);ct t/-hr+ jJrtt:<&..s.lh.-.
Address of Owner: '61 (,. K e e ;.) 1J f 1/ q? t..,J
Meter(s) Size: ~
Meter(s) Use: Check the Use(s) that apply.
Typical New Construction
Single Meter
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Typical Multi-Unit, Multiple Meter
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.. MaDISOLA11DN VALva
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Typical Deduct Meter
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Typical Water Use Only Meter
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I ~ -.clINCI CONIRCL VALVE .
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Note: 1. A Plumbing Permit may be required prior to the installation of the issued water
meter(s).
2. All plumbing must be conducted by a Wisconsin Licensed Plumber, except a home
owner may perform his/her own plumbing within their single family, owner occupied
home. For inquiries please call 236-5052.
3. Meters:;:: 1-112" require a bypass.
Mea2.<s wi!l be instsIled and used according to the above information.
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Signature 6f Owner or Agent Print Name of Applicant and CoriiPany