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METER(S} PERMIT
Date
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Name of OWner
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Address of Owner
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Meter Installed At
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Meter (s) Use
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Meter(s) Size
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('Diagram of Use)
Meter will be installed and used according to the above information,
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OWner oj VAgent
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To Water Utility: Requirements have been
install meter(s} at the above address for
met to purchase and
size a~se indicated.
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