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SI.Priebe4M7-16��6 I � • �
<br /> W.D.Form 3
<br /> CITY OF EVERE I'I'--Water Dept.
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<br /> Application No..�_`..'`:: :�_i. D te.......�c'...�.:�.:.�..._� .19..�/
<br /> „ Install.......'.:.�............__...inch water service pipe
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<br /> On ..............�G:...-�.�.....l,:'r_.."...."_...:i...`..::..'..._'._' :'."_;--....... Street
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<br /> Lot.............................................................. Block No..........................---...----
<br /> Addition ............a................................................ ......................................�--
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<br /> ftemarks �'��"� ' `
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<br /> ,�; �� LAROR AND MATERIA.L USED ��'
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<br /> No. Hours Labor._................................_�?i/.Cost....3_�.:.V:� ..........................
<br /> ' Cut in.../.................Pavement....................X........................ ........................Sq.Ft.
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<br /> ��� � N� a.� Total ........................Sq.F:.
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<br /> Rema rlcs......... ...............................................................................................
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<br /> OrderReceived...............................................................................................
<br /> \Vnrk Completed....._.................--.............:.................................................. �
<br /> Forcm�n
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