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APPLICATION FOR WATER CUT-IN
TO THE CITY OF ATLANTIC BEACH:
Application is hereby made for 3/411 Tap water cut-in
at the following address for unit(s) .
Cut-in charge of 85.00
Street No. 153 Belvedere
Lot 596 B I ock Subdivision AB
Ordered by
Y
T - 77/%ZZ.-tT
Owner �dwar�dZAshurian
Mailing Address
P.O. Box 50003, Jax
Date
Account No.
Meter No. Date Installed
c, 4, T 717 7
/cod
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