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Name of OWner
Address of Owner
METER(S) PERMIT
Date
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Meter Installed At
Meter(s) Size
Meter(s} Use
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Meter will be
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instap,~" d an7ig#, .,to the above info=otion,
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.....--/ ' (OWner or Agent
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#lumbing Inspector
To Water Utility: Requirements have been met to purchase and
install meter(s) at the above address for size and use indicated.