HomeMy WebLinkAboutWORK ORDER - 04-00270 - 273 Rebecca Ave - New SFRACC# RT#
NAME U, a ,Ja
MAILING ADDRESS
OWNER
ADDRESS O o
EMPLOYER OR RELATIVE
COMMENTS
SS#
WORK ORDER
EFFECTIVE DATE DATE
SERVICE ADDRESS
❑ IN
❑ READ
RENTING
❑ ON
❑ RE -READ
❑ BUYING
❑ OUT
❑ CHECK LEAK
SELLING
❑ OFF
❑ WTR.SWR ONLY
❑ OWNER
❑ VACANT
❑ GR CONT #
❑ BL CONT #
METER SIZE
LOCATION _
COMPLETED BY
NAME
PHONE*f, NO. OF PEOPLE
WORKPHONE 3Sb-SP(,
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE
AMT REFUNDED
AMT. APP. BILL
GR RT# BIN SIZE NO, OF BINS ❑ ❑ ❑ ❑ ❑ ❑
ISSUED BY
APPLICATION FOR REXBURG CITY SERVICE
❑ COMPUTER FILE
WATER SERVICE: Type Size 1 7
Water Connect...... $
Water Meter .......
$
Meter Box .........
$
Ring 8 Lid.........
$
Curb Stop .........$
Seller ..............
$
Sewer Connect .....
$
TOTAL ............
$
In City Out of City
Storm Drains — $
APPROVED BY