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METER(S) PERMIT
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Date
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Name of OWner
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Address of owner?) ,r....
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Meter Installed At
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Meter(s) Size
Meter (s) Use
Meter will be installed
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fDiag~ o~ Use) .' //
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and fused /~fc~'~7q~~g to t~~/ above
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OWner or Agent
information,
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
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