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lVI'I'U Installation,Request Form
Time
5//~/00 ..
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Dale
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Account Name {;l( I1CtlVi ,<;-J~
Address (t? I. ~() /5rJ1 h S t ,Sr;
AccoWlt.# O()a 5 /}S7JiJ
Meter size
i if
Meter SIN
{l~ rndt4
4q &3" yf}W
MTU# 5'3D/d7
(CD
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Check the rollowihg:
Flow (y' Meter seal a Main on ~
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Comments 0)/ d / Of?) rn"J1c l/r0 bet !/YUJ{ tJ..J- .;
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ACCOUNT #
ADDRESS
OLD METER
Ser. No.
2503553'5
Digits
Readina~L;"7)~ bb
July Read: 468600
MIU Ser. No.
MIU Phone#
I
. j
Bldg. Type:
No RPZ Ser. No.
RPZ Installed Yes
Service Size
G~ound Yes - NOrc
Comments:
257600
\q~
~.~, q"'<'~Al
X /0,';; .
J 150TH Sf SE, 6130
LEAHY, MIKE
NEW METER
J
Ser. No.~1 () 3
Reg.No. ~
/ Size 5/~ rrK
I'D C:A /,
'/
c:; 7,~J Z,
Port 1
2
I
''% Type
Lead_ Copper2 Iron Pipe_
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. ~~ 1'flr~IRE IN PLACE.
OCCUPANT'S flGNATURE ll/ ( ~~ ... .'. .
DATE /1 ~ ot PHONE '/
From 970 (J-9h) . Copy 1 Customer
I ~_,?1. .,....
iIi.::,.
Copy 2 WS
Copy 3 & 4 WD