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ADDRESS_~~'~5 Nlarico~a Drige ZONE R-1B
OLD ADDRESS
DATE TYPE NATURE OF WORK OWNER
CONTRACTOR VALUATION
5-17-7
B New House with
attached ara a
Paul Ansfield shelter Design
G
4 200.00
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METER(S) PERMIT
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Date /; ', � 7117
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Name of Owner C /I - f1 w n./
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Address of Owner / r� . /,
Meter Installed At /_ I 7 '�,. ,- ,. <A ; 641
Meter (s) Size r ,..t A >L' , :f I -- _�d 8 )6i�=.e � ,--
Meter (s) User=./ -,`i'. ,. i '</ 4 .----.. 4'/S Of,/ 'vrf, , "4°14
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1 ' f t ris t o (Diagram of Use)
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Meter will be installed and used according to the above
information, -
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;I 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. (y
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L PPbing n tor
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