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� 9 -»%� � <br />w. o. ro11q o� � ✓✓ <br />- -CITY UF EVE1�E"IT--�vJater Dept. <br />„ _ , <br />Application No�_'��yyf� Date......, '.._':�....�__.�....,.._--....19:; y <br />Install........_ ............... ._ .inch water service pipo <br />For........................................................................ � ..................................... <br />On ..........�.y�_�:......✓�z+�-,.�.r��;;., � Street <br />......._.. / ...................................... <br />I.ot .....................................................-....... IIlock No.......................---........... <br />.9ddition ........................... <br />_ _ ..................... .................................... <br />Remarks......_�:::,:...r.�-,r..:..l� � ............._............................... <br />_ . .......... .... .. ...--....... ...... ...................... _.........................................--............ <br />Superinlendent <br />LADON AND MATERfAL L�SEU <br />Na. � Size I <br />...........................I..............__.........I :.ead Connectiou Complete <br />..................................................... Se�ddlc Cmnplete <br />...................._il.l........................... ....... _.. __........._....._..............._..... ................Pipc <br />.................................................._ Scrvicc Cock <br />........................... ................:......... Servicc Box <br />No. 2iours Labor .............................................Cosl.................................................... <br />Cut in ...................Pavement..._...............X......................-- <br />........................Sq. Fl. <br />....................X........................ .� <br />....... _ ............... <br />....................X........................ �� <br />........................ <br />....................X........................ ,� <br />......... . .............. <br />Total ........................Sq. Ft. <br />------ ----------- <br />_ —._ <br />Re�na rks ........................................................................................ <br />................................................................................ <br />Order lieceiced . .................................................... <br />1VorkCamplcted ................................................... <br />�� �.����Foreman�� I <br />