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APp�•"���� � CITY OF EVERFTT `3ERVICE <br /> No. • ORDER NO. <br /> APPUCATION FON WATER SERVICc <br /> - . DAT�t 7�-`-�_ 3L�__ 1�, <br /> ,tJi FI%ED <br /> h �� W.O. <br /> � DEP0817 i ��,!n . No.__-----'- -- . . . <br /> / p / ///' � � � <br /> BERVICE �er♦ n[n�.JO�� . ?,�G24�[.�rt L'� .{-C,.�-[.Ll'�__ULK�.�I.-__10Ty� �D�•lc•L'��72ffi- <br /> �iy�q_J �� �tl�iJ . �'ONTRACTOR_ - _. .... - <br /> OWNER '- _ r'��.i _ . . ' . " __ . _. __._. _. . <br /> �� (FLAL� <br /> INSTM_L:?�� __�TEfERFD SER'/ICE_ . . - . . .-'- �-' . . <br /> I HENEBY APPLY FOR THE USE Of WATEfl IN ACCORDAHCE WITH TNE � �� ( / �/J � <br /> ONf:N�NCES AND POLIGES OF THE W�1ER DEP�HTMt:NT NOW E%ISTING eiuNeo: X . � � �1 _✓ � �`���� -- <br /> OR �S S�ME MAY BE HEREAFTER CHANGFD. _ <br /> __._ <br /> MeTER1�LS I I 3 �N' � CNICE i- AMOUNI _ <br /> —1 <br /> PIPE COPPER GALV..- STEE� ._. � � _ . _-+ .. . -. ---' <br /> in. � in II-�--- . .._.- .- <br /> __--_ _ <br /> CGRPORATION ... ... I . -I...._ -- ...-- <br /> _. _ _ . _.._. <br /> _ _.__ '_ �._. _ '-_ __'_' I <br /> _ I <br /> CURB COCK O7 --I � -I - <br /> _ _ __-.__ ._ -_ _.-1 <br /> -'_ <br /> --- / <br /> SERVICE BO% ___ . .\ P ASTIC -- � � . . __ - .._'__ I _. " _"_.___ <br /> _.� — ___ <br /> _---- <br /> METER VAWE ._ - -�- �- � <br /> .__. __—__.. . <br /> . .I ..._... _ __. _ .. <br /> METER No. .. � TYPE: I �� I .. <br /> _ ..._..{'__ ' ' . __- ' <br /> METER BOX CONCRETE SMALL LARGE ' i � --- ---- <br /> ___ __ _ .. . . --�I _ _- _ _.. <br /> _- __'_ I <br /> T� 3�y__ a'"��a s%� �- � _- ' - _ <br /> _ , <br /> -, • <br /> _ �LS� e���,��<=,e �.,✓�iC����;,�r — _ <br /> / �I - � <br /> -- -- <br /> ---- <br /> — - -I - <br /> -- -- - - - <br /> —, --,-- --�- _ __ _ _ <br /> - -�- � ' ' _ . --- - <br /> _ <br /> __,_- -_ _ _ , _ _ ___ <br /> _ ---- - I ' - <br /> - I � ON <br /> DATE INSTALLED: � pFF 0 SUB TOTAL <br /> //�.��7 7 . <br /> LABOp AND EOUIPMENf RLNTAL I �pUR9 A^�E <br /> coo[ 'i — - <br /> i' �i \ " <br /> / _____ <br /> 1n �- - <br /> . I'--.-- _ . .. ... . .✓ � . . <br /> i -- <br /> n S- - -- <br /> -- ---- - - - <br /> —� __ ���r/f� � �.;I G _ � - <br /> � / --- <br /> —� �..3E d'� _._ � — -- - - - <br /> — -- -- <br /> �, - _ + <br /> __ ----- <br /> — TOTAL <br /> REMARKS: .� � . . -. ....- . . <br /> i • <br /> / � � � � <br />