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S J.PriebelM�b�S� � 2 �� " � <br /> W.D.Form) <br /> CITY OF EVF.RETT--Water Dept. <br /> �; ,: ; ,� , , . - <br /> Applica.ion Vo.,..'...�'_`..�..:..... Da�e.....................1....z...::.,;:...:.- 19.�--U <br /> , � <br /> �nstall............i.�'...`!`_.......inch water service pipe <br /> _ , . _____r <br /> . ,, : , . <br /> For � , � . • <br /> ......................_.._ .-.._..._........_.......:.__�......................._..................... <br /> , ? !i (� ':�_� ` , ^ , ' ' . ,.. Street <br /> On ..........--.....-___...........--......-- -..:..:�:........ -.:.:....... -�--- <br /> . _.. <br /> / <br /> Lct.............................................................. Block No............---..'................... <br /> A3dition ......_..._........................- ...._..._.......... <br /> .............: .......................... <br /> " ..i � . �_._ ' ... ...:..L............ <br /> Remark., ....._.......1 .......:............. �-� -:..._.........':..:. <br /> � __�'---..... <br /> ----/�s`�3:......:............ ..................._.........-�-....._......_... .---�- <br /> ......,..:�'. <br /> . �. ...... <br /> � � A <br /> ... _.. ..... _..... ..................._......._._..........-- -........._.............. <br /> ..... <br /> � <br /> �'`•>� 1 :. � . _.. <br /> � <br /> , <br /> ... ....._ � ....-------...... .............. .................... <br /> . ' ' ...................:........ <br /> -., . ..----... <br /> .... <br /> . .� .�.� I , � j <br /> � <br /> � <br /> ' . .:-`�' �' .._.....................-...._...................... .,...._....:._.'..c.:..' . <br /> .... ..... � ... <br /> � . �ti� �Superinlendent � <br /> � '' /i ' / <br /> LA60R AND MATEF.IAL USED <br /> No. i Size � <br /> ... ............... ............................j I.ead Co�mection Complele <br /> ......_.............................................! Sa3d;c ComPlete <br /> ......................f t............................ ........................................................................Pipe <br /> ...................................................._ Scrvicc Cock <br /> ............................................_........ Servicc T3ox <br /> No. Hours Labor_............................................Cost..........._.......................__............ <br /> Cutin...................Pavem^nl....................X........................ .........._._.........Sq.Ft. <br /> .................... ..................... .. ..................... <br /> �� <br /> ... �� <br /> ....................X........................ ........................ <br /> ..................... ........................ ........................ <br /> �� <br /> Total ........................Sq.Ft. <br /> `----- ------- --- <br /> Remarks......:.................... .............._..............................._... ...... <br /> .............. ................................................................................................. <br /> _....... .. _....... .........................................................._................................-..... <br /> OrdcrIiecei�•ed_..........................................................._................................ <br /> - .'✓ork Complrted....... ..:......:........:............................................ .......... . <br /> ' Far��rc:an... I . <br />