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I �O �� f // v��S <br />.,. o. .oa., � v <br />CITY C?F EVERL�'I'--Wat�r Dept. <br />Application No.l. Sn.�ii.%. Date........�::...1 .......................19..C:::� <br />/ Install �... ............. .......inch water service pipc <br />Fer .......��. [r:�rL:._....CYJs��,.. , .. ......_..... <br />On..........._7.G_l..: � _.........�G.� �'�. ' ..............................--....... Street <br />Lot......................._...._...........................�' Block No..----....................._......-- <br />Addition........................................................................................................ <br />Remarks........._.._ ...............,....--..........._.......... .. . .. <br />_ .........................................G..�:,�,,.�j��r..:z.-�:.:�'... ......................- ----..... <br />........................ ..................................................................................... ... .�-----... <br />................... .............. ...... ................ <br />Superintende..t <br />LABUR AND MATERIAL USED <br />No. j Size � ___ <br />— - � <br />......._ ........................................_...I :.ced Connection Complete <br />..___ ........................._..................., Sau�lc ComPlete <br />No. Rours Labor........._........... <br />Cut in............__...Pavemenl.. <br />................................. ... <br />.......................Sq. Ft. <br />......._ ............... �� <br />.............._...X........................ ........................ �. <br />...................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />— -- ------- <br />Remarks................._......................................_..................- ....... ......._...... <br />Orde' Recei�•ed.__ ............. <br />1Vork Complcted .............. <br />............................. ................ <br />.._ ..................._......._._.......� ..'..'...� <br />... _ _.. <br />Forc�nan <br />