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�/6O'� 'p` <br /> w. U. I011N ] <br /> CITY OF EVERE'I�'--VG'ater Dept. <br /> Application No./�l.:�E".... Date.............�?r.:.>....c?..:�.......18.�.?' <br /> Install............................. .inch water service pipe <br /> - <br /> For ........x'/....J<".° .. ..::a<.�.�.Cc . . . . .. <br /> ................................ <br /> . ......... .. . .. ... <br /> On ...................,�'�:�:.-::...... .....s?.'..�...�L�a...�.5..).,':....!...._�. 5treet <br /> Lot.............................................................. Block No....................... <br /> .............. <br /> Additien <br /> ................^...................................... ....................................... <br /> Remarks .... �?'< �� %' �' <br /> ...t.....c. .�:........!.:.S:n:�:.......'..�....'.-..l...l..i...................... <br /> ............................................................................................................................ <br /> .............................................................................................................................. <br /> ........................................................................................................................_... <br /> .............._............... _ . ................................................................................ <br /> Superinlendent <br /> 9 LABOR ArD MATEfttAL USCD <br /> No. Slze <br /> -- ---- -- <br /> ---- <br /> .................................................... I.rnd Cnnnectlon Complelr <br /> ......................... ........._..............I Snddle Complete <br /> ......_ .............St........................_. .............................................._.......................Pi�: <br /> ..................................._............... &rvice Cack <br /> .._._................... .......................... Scrvlce Box <br /> Nu. Houra I.abor__................... ......................Cost.................................................. <br /> CutIn....................Pevement ........_.........X....................... ........................Sq.Ft. <br /> ....................X........................ �� <br /> ......._............... <br /> ..X........................ �� <br /> ............... ...,.................... <br /> .. ................X....................... �� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> .�.��t.��t=s-- — <br /> Remarks......................................................................... ................... - <br /> ......... . ......................................... .............................................. ............. <br /> ................................................ .... .............................................................. <br /> OrderReceived ................. ...__ ... ..................._.............................. .... <br /> \Vork Completed...... ._ . __ __. ........... .... _........ . <br /> Foreman <br /> / <br />