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RECORD OF SEWER. AND WATER DISCONNECTIONS
Date lo - l� -'�9
Address of Building 5 / I L
Name of Owner IP cra,L ar f3lf2.4=4 W .b,
Address of Owner r
Sewer Sealed at Property Line
19 by
Water Disconnected at Property Line,
19 by
No sewer and water services to premises.
I, the undersigned, owner or agent of t
agree that all sewer and water service will disconnected a
sealed by Property,
Y a master plumber on or befo and
Owner Agent
Approved fo ► is$ :nee of wrecking
g or movin• = m Aoe4/0
& 7 AOP
e 4107 r AIL dOitir
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