HomeMy WebLinkAboutSewer & water disconnect
-_.!.._.~
RECORD OF sEWER AND WATER DISCONNECTIONS .
Dat~ ;: ~{/r~L/ /( %
Address of J3Uild1ngj'l/Q,Wu,cl<f.A1 .
Name of Owner I~T0fjttj {(~\..A~~;:;;t:r\../
Address of Owner '.IJ.O.~ taDA ~1l\h/~.f))fJ.,
Sewer Sealed at Property Line 19___by
Water Disc.onnected at Property Line 19___by
,. '.........::.,~,.. ,'.;
No sewer and water services to premises.
o
I, the undersigned, owner or agent of the above described property,
agree that all s.e:we:r' and water services will be ~di agQR~Gtoo an~
S$eJ eA fT. __~"t"r ~'IPP~" ">' .1'be~"" U ~ ~. .( . J'" r-
AI,,-""'Aw<;-<v, r<L-~'f'C" f' .. J"~ ./L~
. tirwneif ....... . .. (Agent)
AppJioved 1/ 1.s~.uance
a(s. x(: . '
Date' I
of wrecking
'.