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_ - ✓� <br /> /�GC� � �� ��' S' <br /> C--Water L)ept. <br /> APPlicat`.un No.��l r::4.1`/.. Date............N;R.1... 1362............19...... <br /> i lnstall..._......s..�.... . inrh w�ter scrvice pipe <br /> ......... . <br /> rr. ._.`,... ,ct<r3-�.�.''............... /�C.{. ,r...C_.: �.._........................ .... <br /> _ �.,.. �� .� <br /> On .._......�a_��C7- ,Y....--..f-�![rt..:.2{..-f.��---=......:�:`�... Street <br /> Lot...............................--........................... Block No....---�----..........-�--�---- <br /> Addition ........_.. .........._............................_........._- .................................._ � <br /> Remarks ._....................�--......---• .-........................................----............... ; <br /> ................ ...................................................................................................•� <br /> _........_ .... ........................................................._............................................. <br /> ....................................................................................................................�----... <br /> ...............................................................................................................�---��---- <br /> � 5aperintendent <br /> L.1BOR AND MATERIAL USFD <br /> No. Size � __ ___ _ _ <br /> ---- <br /> ................_.._.__........_................ :.cad Connectian Cumplete <br /> ....................................................... Saddlc Complete <br /> .......................ft.........................._ ............._......__........................__....................Pipe <br /> ..................................................... Scrvicc Cock <br /> .............._..........__...............,......... Ser���cc Box <br /> .......................... ........................... ................................................................................................................ , <br /> No. Hours Labor......................._.....................Cost................._.................................. I <br /> Cuc in......_._.........PavemenL......... ........X_....._............... ..........Sq.Ft. <br /> .............. <br /> ....................X........................ �� <br /> ...................... <br /> ....................X........................ �� <br /> ........................ <br /> ....................X....................... ,� <br /> ........................ <br /> Total ....................Sq.Ft. <br /> — ----- ----- <br /> Rema�ks........................................................................................................... . <br /> ....... ......................................................................... ....................................... <br /> ......... ................................................................................................................ l <br /> Order .Zeccived............................................................................................... <br /> \Vork Compleled........................................................................ . . .- -.... <br /> oreman <br /> 1 <br />