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5 J.Prie W 1 'S / <br /> 0.'.D.Fo � � � � <br /> IT�' O E ERETT--Water Dept. <br /> , ,. , � <br /> � <br /> Applicatiun No.:.�.._�.-:_J--._ Date................_:.:�_i..:�..:::.._....-.---.19:::... <br /> ii <br /> , ,, { . `' ................_...inch water service pipe <br /> nsta <br /> � �1 / I ........... .l - . ., <br /> For .......:.ti KG.... �.. c <br /> _.,_........ ..._....._..._........................... ..._' ---...---- <br /> On ........::.�..1..1...;r.....:�<...:_:..:._:..:.:...::..::........_..........._........----... Street <br /> Lot..........- _....................................!.......... Block No........_----....-----....--.....-- <br /> Ad�3ition ...............................................................................�----...............---�-� <br /> Hemarks � � ' ^ ' ' <br /> � .- ----- <br /> .......,......................... ....................._ <br /> ,..... -•---�.................................. <br /> � � <br /> .... ......ti.a�:. . .. ..... . �... ....................................---.........-----....._... <br /> . . <br /> b+o �...,�--I b, <br /> .,,+1?i�,.....y . .... ..�..G. .J.�y.rl-. ............. ..................-�-�----...---.....-- <br /> , <br /> �...... .... .-i::..�.....................-...._............._.............._---- ._ <br /> . .._ , <br /> . ..._ <br /> ......i.:_ . ._�.. .. ............................._...__......Su ertrtlend <br /> . , <br /> . . .................. _ <br /> , �'�•? \ P ent -.� <br /> _ `.� , <br /> I.ABQR AND MATERIAL USED <br /> No. I Sizc <br /> —— <br /> ..................................................... Lead Cunnection Complete <br /> ........__................................_........ Saddle Complele <br /> .......................tt............................ ........................................................................Pi pe <br /> � ...................................................... Scrvicc Cock <br /> ...................................................... Scrvice Hox <br /> ._................_......._.....:..:_-:..._..... .__:._............................._........................ <br /> . ................................................ <br /> ..................................................... ............................................................................................................... <br /> No. Hours Labor......................_......................Coct.....---..._....................................... <br /> Cutin....................Pavement...................X........................ ........................Sq.Fl. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ �� <br /> ........................ <br /> .. ....................X........................ .� <br />, ......... <br />��:..,:. Total ........................Sq.Ft. <br />��-�- -- —�---------�— <br /> ---- -- <br />;I rZemarkti...........:........._.............r.. ._...................._........._............................... <br /> ' / .! <br /> - � .............................._........... <br /> y _ ................_................... <br /> li- —�-��� � <br />: . ............ . .. . _.. ... ..._.................................................................................... <br /> QrderPcceired................... ................................................... ............._.... <br /> 1t'ork Cempleted...................�........._........................_............................. <br /> � -- � ,� �� �.r Foreman <br /> � ' <br />