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Assured Self-CS030421
DONALD VALK 1334 DBA GOPPELL 1001 W PLEASANT RUN 32 104/1 0 ~ DESOTO, TX?511§ -- ~!~"., E ~ ~ P.O. Box 478 ~ 214-304-3S45 Name /~'.~/, * ' : .... ~ ,'..G. ~ ~:. Diite //~-' ,/ ~ Check NO. I WATEn TAP ! METER INSP. FEE SEWER TAP I~. FEE U~ ~L ~. ~E SE~m~ ~WA~R WA~R T~ ~E ~ER TAP ~E CUST~ER ~ ~OW ~1~ BA~FLOW ~1~ ~TED ~TRA~ ~TER TEST FEE 2 3 4 5 TOTAL