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M'l'U Installation. Request Form
Date' Jkdrh I
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Time a/7 ~L tL IYU...
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ACCoWlt Name~ )t rJ_
D51.cJ7/05
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Address-L{AV 7 .f1w.J, ~ S1:
(J()D 7d700
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MTU # () CJ -S ~L/-. 5_~
ACCOWlt #
Meter size
Meter SIN
Check the f?llowihg:
Flow V Meter seal ,-
Main on I /
Comments
LflcJ7/()5--
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hlstalled by r P cf /VA
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.~'!t~-'Fr<' 4"~ ~-;-"'T-. --.-...~:
727001 ~ .
ACCOUNT #
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OLD METER
DUTCH AVE SE, 165171
MATTHEES, KATHI ..,Sta{I !ne.&q.,
NEW METER f'
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ADDRESS
Ser. No.
23090099
Ser. No. 7710'1- I..f- ?r I
Digits
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Reg.No.
q '}Jf7ru I size;J.k'))~ IDc.q V
July Read: 922100
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Readino
MIU Ser. No.
MIU Phone#
Bldg. Type:
Port 1
2
RPZ Installed Yes No RPZ Ser. No.
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Service Size "~ Type
Ground Yes X No_ Lead_ Copper~:?n Pipe_
Comments:
.,
Please keep this receipt for your records. The final reading from your old water meter
will be used in determining your next regular bill.
If you have any questions or problems, please contact the Water Department during
"'-.Q()rmal working hours. Thank you for your cooperation.
INSTALLATION ACCEPTA~~lW'ER ~ERISE{;L WIRE IN PLACE.
OCCUPANTS SIGNATURE lflt/VJ!lt /, Jttt--1
DATE ({/ I,vd?- 'V ~HONE 4/7- /11'17 I j
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From 90080 (4-93) Copy 1 Customer Copy 2 WS Copy 3 & 4 WD
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