HomeMy WebLinkAboutSewer & water disconnections
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RECORD OF SEWER AND WATER DISCONNECTIONS
Date
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Address of Owner
of Building ~.3;;) E. f ~r k ILJ .~.... '-L
! 7
Vr.a.. 111/ /c!{ ~. n/, <:;: 1-
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Address
Name of Owner
7/5'"
Sewer Sealed at Property Line
Water Disconnected at Property Line
19_by
19_by
No sewer and water services to premises.
o
I, the undersigned, owner or agent of the above described property,
agree that all sewer and water services will be disconnected and
sealed by a master plumber on or before. ~.j.,- / / I~Y{)
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(own~:;~ , ~/~(
Approved for is~uance of
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wrecking or moving permit.
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. Plumbing Inspe or.