HomeMy WebLinkAboutSewer/Water Disconnection
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RECORD OF SWNER AND WATER DISCONNECTIONS
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Date
Address of Building
Name of Owner /11 <cr-. c-. /
Address of Owner? ~ /
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Sewer Sealed at Property Linel ~~ 6
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Water Disconnected at Property Line
No sewer and water services to premises.
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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
(Owner)
(Agent)
Approved f~or issu...ance of
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wr.ecking or moving permit. ~
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Plumbing Inspector