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�r+'D�c-x�-z <br /> _ . `tA/. ` E=i+ rv.K7�t-2v - f}� <br /> �4.D.form{—I,;oo—E.Rca.—t.as� <br /> City of L' verett�--���Tater Depai�tinent <br /> APP�.ICArI'ION FOR WATER <br /> i+ll b'.anl:s mnst Le filled in or crossed out <br /> ceerc tt.................._............_E`. U ..1�J2.� <br /> --`.............._..l.......... <br /> TO THG SUPLRINTENUI:NT OP TIiF. NATF.R DEPAItTTiENT: <br /> CITY OR SVII:L�TT; <br /> I hercby nppiy fur thc use oC tcater in acccrdance with the rules nnd regu- <br /> lutions uf the R'at^r Department, for pmposes ar,d fis'u:es atuted Uclow. <br /> During tLc timc thnt nny OI tI1C �41tCT mnins mny Lc taken up Ly rcasnn <br /> o[ nny iiaprovements anihorized Uy the City oC Eecrett, in or oC nny ntrect or <br /> alley in which they m�y hace been la?�, the City will not be required to furnish <br /> �eater dnring the progresx of such improvement� to any cansumer whose ��ipply <br /> may thus bc cut off, or bc liable tor ;,ny damnges for its tailure so Lo do. <br /> Ap�lication ro............q.�._53....... <br /> 61ock..........�^�-'-..�'}............. Lot..._1.�.........._.................. Add.__...._ __..._. <br /> ///ppp ��� �,,,, ��^ ._.. ._._.. ..... <br /> No ...a2_O ot �. ..... �,_.e-�Cny .. ..... Strcet <br /> . ....__.... . .... ...._.Q ... <br /> .... . ...._...... ...... ._. .._... ......_...... <br /> The wurk to be executed by._..._ .._. .. ._. _... . ..... ... LA../............Plumber � � <br /> St te size of tup. . <br /> M1 .fi <br /> -� Y..._Tnp to be ir,serted in Lhe m:iin. � � � � <br /> . .�,� ...Wntcr rlo,et �� �� � y..� ''. �� e' ii,..F <br /> ........Bnch �/ o d �' 11 . . <br /> .........._....Urinnl (V � � V <br /> ._..__........Plei� faucet insidc �{ � r� <br /> _._._........SiJc �valA u•asher . �N�/ � lt]. O a-7 �I-d <br /> ................Hosc Lib oulside <br /> ................liosc biL for buildinfi p�rpn�rs <br /> ................Iiose bib insidc <br /> ._. . ................Bib tor stnbla cnntnining....._............=tall.........._._..... <br /> ..._...........ATumb:r o[ persans in family <br /> .Numher of roome in building p � <br /> ......... . <br /> The piemises arc ta bc used ns n ....�..1.2.��N e e/. .,�I _... . ..... <br /> The owner of LUe premises is._...U-?.�__��� -..�-�a-�,., ,.. <br /> Theagent is....._._........_.........___....._........................_.__...._......._......._._.............._. <br /> This npplic:ition, nithough signed, chnll not be binding upon the C' �, until <br /> accepled by the Supm•inlende�.t nj U�i j,�Vn�cr De�tm n <br /> :=���,Ea.............__....�,(,�'1/�...���1_�.'�,.�-r=�.-....:nPri� c <br /> n��� �t�a /O-A.- � � . <br /> � / ,�......»z_.... By. ,�/ . . ...._ <br /> � / Supenntendent <br /> . .- hi'6'�d:F7'1 e �<�.�±�.e> . . <br />