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CITY OF EVERE_TT WATER DEPT. <br />APPLICATION FOR SERVICEAND OR TURN ON - SHUT OFF ORDER <br />I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE ORDINANCES <br />AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING OR AS SAME MAYBE <br />HEREAFTER CHANGED. <br />TYP BCD NO I SUO •vvT R[v SRC UNITS <br />DATE � a_ 19 � 5 <br />EAPPLKATION❑TURN-ON❑SHUT-Off❑OMEN <br />A13MTION <br />SERVICE ADDRESS 7o j' � Ld 1. <br />BLOCK LO* <br />CONSUMER "^ -:C4a OWNER ❑ <br />TENANT O <br />OWNER <br />CONTRACTOR <br />g ADDRESS <br />RECEIPT J . FIXED <br />NUMBER ., DEPOSIT RE, EITP VVED $ BY <br />SIGNED: X <br />REMARKS: <br />SERVICE l <br />ORDER NO. dp" BY- <br />. . - _ <br />WORK COMPLETED <br />APPLICATION NO. <br />967/ <br />