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i Z �,; <br />w. O. IO�w ] � � �• ' � ���'C� <br />' CITY OF EVER�Ti --Water Dept. <br />Application No..� � = ^:G .... Date.......:: ...-1...... :.:. � ................19...... <br />Install.........._ ...................inch water service pipc <br />For........................................................................................ ........................... <br />�i � , <br />`� `�� Y.i:<...�:::. �✓......:� <br />On .................�..�...t...:........ . . ".� J .x.7.7.:................ Strect <br />Lot............................................................. Iilock No..................................... <br />Adclition.......................................................................................................... <br />Rrmarks .::.............. . . . . . ... . . <br />... ... ......... ... ...... . . ... .. .......... ........................ <br />� .... ....... <br />; � � <br />„ <br />................:..r..... .......:......................................................................................... <br />4/ r: n� .............^ ............ <br />,f. 7-,. s �i <br />Na. I Size <br />LABOR AND ]1IATERIAL USED <br />Lcad Connection Complete <br />Snddlc Complete <br />.................................................... <br />Scrvicc Coek <br />Scrvice Box <br />No. How•s Lsbor .............................................Cost...................................... ............ <br />Cutin ....................Pavemrnt....................X........................ ........................Sq. Ft. <br />....................X �� <br />..................... ........................ <br />....................X........................ �� <br />........................ <br />....................X........................ ,� <br />....................... . <br />Total ...................... Sq. Ft. <br />Order Received......... <br />Nork Completed...... <br />.........._ ...................�.�.......'Fareman � � <br />