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ADDITIOPIAL CHARGES�R
<br />SA�ITA�Y 6EWER (and�or) WATE�. �gESSMENTS
<br />Department of En�ineering
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<br />Uwners Name: �YU'•.-� � �.... f , � �i'��
<br />L�,te �/� .3 ,�� �
<br />Address_ _ � �l � i�.i . ' j . �?,,,
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<br />Add. far legal �O`� U!•�. �.� � G�
<br />Code No. `'�jg - u� ��,�?U �- D �D-. �
<br />�.�egal Descrip�ion:
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<br />�mOun� assessed. �or Sewer $ ��
<br />Amoun� assessed fox Water '`�
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<br />� :: AAc�..c�3.tional charges $ �G� � - � � � ,� . t,� ��<
<br />Addi�3.ona1 ck�arges � � � ` -�...,,,�.<
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<br />�b-�al a,moun�t due $
<br />Tnvr�i c e No . ^���✓ � � �--�
<br />Amo un � $ D�,ted
<br />Recea.pt No. Amaunt �
<br />D�,ted
<br />Payment received by
<br />Calculation by
<br />Return orig�.nal to Eng�n���,ng .
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