HomeMy WebLinkAboutWORK ORDER - 04-00210 - Tuscany Place Apartments - Bldg 4APPLICATION FOR REXBURG CITY SERVICE
NAME
WATER SERVICE: Type Size
Water Connect...... _
Water Meter .......
f
Meter Box .........
i
Ring 8 Lid.........
$
Curb Stop .........
$
Setter ..............
S
Sewer Connect .....
s
TOTAL ............
_
In City. Out of City
Storm Drains — $
APPROVED BY
WORK ORDER
ACC# RT# PHONE EFFECTIVE DATE DATE
NAME Taj Nl-� C3Ll6C�'.1�-- SERVICE ADDR'ES'S / I ,. N CIL (fir
MAILING ADDRESS `j3 N N(4&1,SOtal 17k,ui:E I�t4�d E /1�
OWNER SGQLhIS/�L/OC'i/ %�Ur*1`/OGtI PHONE .Id9-AI l0 NO. OF PEOPLE
ADDRESS -,'rV4* /Lr
EMPLOYER OR RELATIVE WORK PHONE
COMMENTS
SS#
SIGNATURE L K''//W
t� -
❑ IN
❑ READ
❑ RENTING
DEPOSIT AMOUNT
❑ ON
❑ RE -READ
❑ BUYING
DATE PAID IN
❑ OUT
❑ CHECK LEAK
❑ SELLING
REFUND DATE
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
AMT. REFUNDED
❑ VACANT
❑ GR CONT #
❑ BL CONT #
AMT. APP. BILL
M T W T F S
METER SIZE
GR RT#
BIN SIZE
NO. OF BINS ❑ ❑ ❑ ❑ ❑ ❑
LOCATION
COMPLETED
BY
ISSUED BY
❑ COMPUTER FILE
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