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CITY OF OSHKOSH WATER DISTRIBUtION
WATER METER PERMIT
(please Print)
Date: 5 / b/ (C) f;{ -
I I '
'Meter(s) Installed At: ~ ~ c..( S ti () [. L L e: IL - 5T
Name of Owner: L- p...1A..I.[j N\ A. w1.-"- ' ~ L- ALA
Address of Owner: _ S"ft,ri e
Meter(s) Size: . ~ / ~ ' ,
Meter(s) Use: Cbeck th~ sees) that apply.
Typical New Construction /'
Single Meter
. 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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110 SAMr....
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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 hQme
owner may perform hislher own plumbing within their single family, owner occupied
home. For inquiries please call 236-5052.
nters~ 1-1/2" require a bypass.
Metr(S) ~ e' .' . and used according 10 the above infonruUion.
.6
Print Name of Applicant and Company
I ~ ~CCMIIICILVALVE .