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�roi%'-/-3�-a.3 �� . .. �rf"T.- <br />. <br />W. D. Form � I SCO 0-�-� 7 G P. <br />CITY OF EYERETT==Water Department <br />� <br />,�pplication for W/q/at�r <br />AII blanks nms[ bc d in or crossed /+� <br />•�' � .,._'.9� <br />' `� Geerett.-.__ . '-_'. <br />A,� / <br />.. '______/-_._-._-. <br />TO THL SUPGRINTENDIiN7' C E NA'CER DEPARTT��NT, <br />1�17' OF G7ERETT: <br />1 hereby apl�lY for the use o( watcr in acmrdance aith thc rules nnd regula• <br />tinns of The 1Vater Departm mt, fnr purposes and fixWres stated be�o��'• b reason ot <br />During thc timc that any nf thc �catcr mains may be tnken uP Y <br />:�nY inprovemenls authorizeel by tlic City ��( ��'erelt, in �r o( anY sVcct or aI1rY in <br />tM1C 1 f`�f ss uf uchei nproven ents lo any consunmrrwhn.ce supply'�n�a>' �� us bercut <br />off, � r be 1ia61e tor any damaF« f��r its tailure so to Jo. <br />h ,ir... ', � <br />Applirnlion NG��.'-� �'f �'---- . . , �� � �. <br />I31uck __� _ _ ot'__'�� � Add. :ls,.l��_-�:'___'•;.__"�-. <br />O -0_ _ . . <br />z, - _ Slreet <br />_""_"_"- <br />No...___. _."_' <br />_"""""_"""" "" <br />'""'_"" _""' <br />( __...____'____'_"_"'"'""""_"'_ <br />"_"".. <br />""' _'"" <br />-' ' "_"__"__'-_' ' <br />. .'__'__.'______'__-_' Ylum er <br />�'_ �,fhe work to be executed Uy.--'---""- - <br />State sisc of lap. . . � / � __. <br />�]J_Tap lo be inurted in the main. <br />1 <br />_._.__,.Water dnsc[ <br />__.__' _._"�iJIII <br />'_'_'_'_ Urinal <br />___"'__._Plain fnucetinsidc ,��� ;; . <br />Sidc walk w•ashcr '{�F'�� (� `, <br />� �-"-' _._Hose bib outside .,Y I��,1'� i <br />_'_.'__ _ l� ' . <br />.""'___'Hoschib(or6uildingP��D'�scs . �,. _...r, <br />i <br />__"'___Hascbibinside � . <br />_stall_'_..' _ � <br />_""""_Uib forstaUlc containinK.'---"'- / � <br />__ p7umbcrof persuns in fami�y - � , <br />'_'_'%� bumbcr of ronms in �uilding <br />'Che Pcemises arc tu be use as a""' --"--'--""-' <br />"'_."__""_ __".. <br />The owner o( thc Premises ts '_"-' --'-'- <br />'___'_'.___._'____'___"___' <br />Thc aKent is . "_ -_'-. _ _ --'------' <br />""' '___..____"""".______"___ <br />This app������oM �����ough signcd, shall not bc binding upon the City, until ac� <br />� rpteJ Uy The Superinicndont of thr 15'ntcr DepartmenL � <br />�7� � __. . Lc�nt <br />Signed _._). __ . - pp' . <br />. Y- �_ __ ,� __ �_ <br />,5, �.. ,. ' � <br />Aeccptedf �.. - . .--`------------------- <br />`'^=�`�j "' � f r l� Sucerlmendem <br />• •P R � <br />) <br />. . `.�i�=� <br />