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��nr �� g- 3 - � i,>� <br />W. D. Form 4 IL00 J-617 C. P. <br />CITY OF CVERCTT=-1Vater Departme�tt <br />Application for Water <br />All binnks must Lc Llled in nr rri.,:rd �uyJuj <br />Iivcrett.-___.____'__-____."I-_.�__.___'_191 �� <br />TO TNE SUPERINTENllF,NT OF THE WATER DEPAR'fMENT, <br />CI7'Y OP E7GRETT: <br />'� I hereby apply for the use o( water m accordance w�ith the rules and tegula• <br />� - tinna r,.' The Water Uzpar[mrnq (nr purpn4es and fizturce staled below. <br />� During Ihe ume that anv of thc w;rt�r mmns may be taken uV �Y reason o( <br />, . any impmvements autliorized b� the Gly o( G�errit, in or o( any stree: or allcy in <br />. n•hich [hey may huve betn laid, lhu City a'ill nnt be required tn lumish weler during <br />. �he proGress n( euch improvemcots tn any con�umer whose supply may� Ihus be cu[ <br />� nf(, or be Iiab�e for �ny damaK^s for its (ail�ulr�e so rto� J�jo. <br />AppliCalinn Nn.. � -'7 Z / J <br />f3luck _ /d��.�(o 7 -/-�Lot/.J ���_�6�..��(� ._. Add..--- <br />nf)._...Ic'_-.i d- �..!�POI!aJJ....._" .,( �._..S�TIC'i <br />. ..... . . .. __.... . � . ._.. <br />'fhe wurk l0 6e cre trd bl'�.,--/J ________ _.. <br />S�,�i• svi i�� �,�. �i%�h U�-.�+-�--"-�a <br />��.�Tap lo be inzerted in thc main. <br />__.___Na�erclosct � � <br />_".. __ _.I3ath <br />___.._ .Urinal <br />._... .___Plain taucet inside <br />..._.__.__Side w�alk washer <br />' _ _ .' _ _ _ _ Hnse bib autside <br />__________Hose bib forbuilding purposcs <br />___..____.liosc �ib inside <br />"""""iiib for stnble cont aininq. _ _ _ _ . _-' <br />.__._.__.Numbcr o[ persuns in family <br />--- -__.------ Plumber <br />� • � z e�-��. . <br />, , ) <br />'� -��� <br />.___..___.Numbcrotroomsinbuildinq_ "" ' ' � -�D r <br />The premfxr. am [n Ue used as a_�. -E+-�-�-�p y�J.�.d,�C,(.�i..a-___'^_.�,l.t-� <br />/'I � • <br />i• <br />The owner of the premises is Q,�. y_i.b`cay„fIY,__��Q-C_S�L�7 �.tJt„L <br />/ " ' � <br />ThcaKentis.."____'__'__.___'___'__"_ ___"""_. <br />7'his application, althouqh eigned, shall no[ be 6inding upon thc CitS', unli� ac <br />ceptcd Ly The Superintend�e t o( the Water Departmrnt. n . <br />SignedC.�lrP2Z-'��-. ___ ___""z-.�plicant <br />1 ) y4?�� ��`i <br />_ � <br />Acc�rtea _ cj'---`-'-_----�=Z Is -- <br />/ -- suuerintend�lY- / <br />�.�.�.-A � -is - �<� - w ;,!; �; r. <br />�5�� '*� <br />�`�t <br />e <br />':� �x�,-',�.::'ti <br />e <br />��� <br />� <br />KN��e� �j <br />r, 1 <br />�"t.�l <br />