Permit 902 Kestner Rd. 904-247-5872 P.O1
Jan-19-99 02: 35P Ftarry McNally ► .v
Jan-15-99 10.45A
PRICE QUOTE
APPLICATION FOR WATER AND/OR SEWER TAP
APPLICANT NAME
MAILING ADDRESS
PHONE NUMBER -�`� 7 G DATE
SERVICE REQUESTED [t')'6 C�'
SERVICE LOCATION-
DATE
OCATIONDATE SET TO PUSLIC WORKS
DATE RETURNED TO SUILDING DEPARTMENT
PUBLIC WORKS DEPARTMENT
PRICE QUOTE RESPONSE
WATER:
SEWER:
OTHER
.W 0. •f �n cR S C..J� B � � G t' ��' c''1�`'�'1_y...,, -1/�
PRICE QUOTE PREPARED SY:
Signature -Title
DATE NOTIFIED OWNER