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❑ SERVICES <br /> Service Facilities Needed City, Special District, etc. <br /> Water /1/Q r! ,e, C ex/S�, G.s�G/�alwi ov�lE•� SG�'ai�E <br /> Sewage � < iG <br /> Drainage 27/41*4641-1 <br /> Electricity <br /> Gas <br /> Reason for the proposed Merger : 7/0 <br /> O OGS !IG <br /> ❑ SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Owner(s ) (All owners must sign as their names appear on the <br /> deed. ) , <br /> ❑ Corporate Officer (s ) empowered to sign for the corporation, <br /> UOwner 's legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and hat the forego* is true and correct, <br /> (Signature ) (Date ) <br /> ,'=Merger of Parcels - 4 - ( 8/86 ) <br />