HomeMy WebLinkAboutCITY SERVICE APP - 04-00321 - Department of LaborNAME
APPLICATION FOR REXBURG C
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PROPERTY OWNER J ti� V`I AT5on1
WATER SERVICE: Type Size '
Water Connect...... $ In City Out of City
Water Meter ....... $
Meter Box ......... $ Storm Drains — $
Ring & Lid......... $
Curb Slop ......... $
Setter .............. $
Sewer Connect ..... $
TOTAL............ $ APPROVED BY