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Name of OWner'
Address of Owner
METER(S) PERMIT
Date
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Meter (s) Size
Meter Installed At
Meter (s) Use
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(Diagram of Use)
Meter will be installed and used according to the above information,
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/ Owner or Agent
To Water Utility: Requirements have been met to purchase and
install meter(s) at the above address for size and use indicated.
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, Plumbing Inspector