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DO NOi FI. `1"I I� O �� ❑ODSMG TILL <br />Ultri�n snur OFr SLWERCONST. NiOG. ( ❑ <br />✓�% O•i NETEE MG <br />�PPUCATION NO. �`� � 10 19Z <br />DATE <br />r.n RCO ACCT. NO. SUB ACC T. ME NS1. R[V. Cl. SIZE NO UNRc <br />J �� � �� OND SRtV <br />BILLING NAME <br />BILLING ADDRESS <br />CITY, STATE ZIP <br />SERVICE ADDRES! <br />OWNER NAME <br />r <br />i>�"�..EJ'1'4, •1:Ir�'f•liY i:7'ti-k�,; -6r'1 _:li,' <br />TURN ON ❑ SHUTOFF ❑ CHANGF. METER ❑ DATE <br />REMOVE METER NO. <br />READING <br />'NSTA ER NO <br />/ READING D Il <br />INSTALLED /177> 7 n/ 7 O O oFF By <br />GATE ENTERED_ <br />DESCRIPTION WATER 5EWER SEWER <br />SERVICE SERVICE CONSTRUCTION TOTAL <br />CURRENT CHARGE <br />BACK CHARD[ <br />OTHER <br />NO <br />549 <br />w <br />