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1\11' ru Installation. Request Form
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Account Name Ow JL;t -tJ tLbW-kV
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Address \.~I '- ~ YLV-- ~Jr .t) !.,(rl SJJ:
Accounl.# 00 6? /rJ 700
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Metee size
MeLee SIN
MTU#
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Flow J Melee seal J Main on . J
Comme.l1b
Installed by
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ACCOUNT #
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10 r; I S () y,-"'- sL k 12rJ
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ADDRESS
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OLD METER
NEW METER
Ser. No.
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~ 7,7 t.f7 () '5 7, Ser. No. 7 7 0::J ~ </-C{!
J Reg.No.
CJ-7 f!;;l7Jf' Size
. l) 70 (/7 1 ~
Digits
Readinp
MttJ"Ser. No.
MIU Phone#
Bldg. Type:
Port 1
2
RPZ Installed Y9! ~ No
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RPZ Ser. No.
Service Size
Ground Yes ~o_
"If Type
Lead_ Coppe~on Pipe_
Comments:
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MW +'.4+0, ^{:J J
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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
normal working hours. Thank you for your cooperation.
INSTALLATION ACCEPTABLE. WATER METER SEAL WIRE IN PLACE.
~ ~/4,,,# -----
OCCUPANT'S SIGNATU~~~ ~'"
DATE 5" - 2 '2 -' 0 ~ PHONE~ ~1;, 1 Ltcf
From 90080 (4.93) Copy 1 -6ustomer Copy 2 WS' Copy 3 & 4 WD