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I <br /> cr'-��zrP r- ��I- v� u/ - -_ <br /> E��iT7 9-:z—z�-��. � <br /> W. D. Form { I500 J-1-17 C,p, � <br /> CITY OF EVER�'F�l.'==Water Depart�ent <br /> Application for Water I <br /> All blanks mus[ bc fi ed in or crucccd out <br /> Hverett,__=--- - '_-/ / <br /> - "-'----- <br /> ...__'._..19 __'_. <br /> TO THE SUPGRIN7'GNUIiN'1'OF'CIi� ATER DEPqRTT1tiNT, <br /> C17'Y O�GVGRE7'T: <br /> 1 hereby apply (nr the use o(�valer in :accordance wi(h tl�c rules and regula- <br /> tiuns uf'Phe 1Vatcr Departm�nl,(or purposes and fixlures stated brlow. <br /> DurinR the time �hat any of tl�c�vater mains may be taken up by raason of <br /> anv imurovenrnts aulhorized bv the Cirv of Evercll,in or of any sircet or nIIeY in <br /> which they may havc hcen laid,�the City a•ill not be requircJ to lurmsh wa(e_ during <br /> the progresy n[such improvemen[s ta any consumer whose suPP�S �»>Y�huc be eu[ <br /> nl(, ur bc liable for an�•da� -�qes far its tailure so to dn. <br /> Applicntiun Na.� �..__"'_" <br /> ' RtrxA .'_""'_'_"' .ot""'_'____""_"'AdJ_'__""__'_'_ <br /> �i��' J7 __.._ <br /> _' <br /> _ "No.._ ._.___'__ _ _..Street <br /> '__"_ <br /> 'fhe x•ork tobe e�ecuted by __ __'___"_"_ '_`________________ ___' plumber <br /> Slalc sizc o(tap, <br /> -`��_."Pap(o bc inscrtcd in thc main. -�y� '%y�`� <br /> �___11'ntcr doset /r' Y :7 <br /> '—'-�___IIath <br /> -_..---' .Urinai <br /> --"'__'_Plain faucet inside � � � <br /> ---"-"'_Side walk n•asher � :�'. �; j <br /> ---.._.._Ilasc bib outside �" � <br /> '--'—___Ilosebi6forFuildingpnrposcs ///�� ' �.' � <br /> -'--"__"Hosc bib inside �{� . <br /> --"".'__Bibinrstahlecontnining.__'__"___yt�IL_. ._ /%)\� ' <br /> --'-."SJ.NuntLcr of persons in famil>• j r�... .. <br /> ----C/___Numbcr nf moms in building <br /> "Phepremisesarctnbeusedasa_________ __ <br /> _""'_"""' '_"" <br /> ''he mvncr o(thc premises is .__..___..__._, <br /> . __'______'___...""'__"'_ <br /> 'Phc agent is..'_"__ <br /> ___".___"__'___'___' '_____'.'___""_'.____'_'_"" <br /> : application,altlmugh signed,shall not be binding upnn the Ci�y, �mtii ae <br /> �Thr yuperinlen(�de.n[of the 1Vnlcr Department. <br /> Siµned_,(1_U✓ �a-� <br /> '�-,-,e-f'--- �-' Applicant <br /> � �.�7,.__'. '_ '_ <br /> �/ "'_ '_' <br /> -eptcd.�._...��. Yw/ IC/ <br /> ' _'._._ __'._"_""_"__'-_/ <br /> SuperlmenCent <br />