HomeMy WebLinkAboutWORK ORDER - 04-00289 - 450 W Main - GarageACC# n RT#
NAME 2APH f3
MAILING ADDRESS
OWNER (?'PJ�
ADDRESS _4i�;_o
EMPLOYER OR RELATIVE
COMMENTS
SS# ,,�% V /O //L (o SIGNATURE
❑ IN
❑ READ
❑ ON
❑ RE -READ
❑ OUT
❑ CHECK LEAK
❑ OFF
❑ WTR.SWR ONLY
[]VACANT
❑ GR CONT # _
METER SIZE GR RT#
LOCATION
COMPLETED BY
WORK ORDER
EFFECTIVE DATE
SERVICE ADDRESS
o N
❑ BU NG
❑ SELLING
❑ OWNER
❑ BL CONT #
DATE
PHONE 3SA-_29 ") NO. OF PEOPLE
WORKPHONE
DEPOSIT AMOUNT
DATE PAID IN
REFUND DATE _
AMT. REFUNDED _
AMT. APP. BILL
BIN SIZE NO. OF BINS
ISSUED BY
❑ COMPUTER FILE