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5 J.'rriebHH:�JS � , <br />CJ. D. Fotm ) � <br />CI�Y O EVERETT <br />Application IQo.�.�Y...��./..... Da��....... <br />For <br />An <br />, �a�� �: � <br />--Water Dept. <br />.................��-�X- -.�'�...1s�i <br />.....inch wate service pipe <br />�;, <br />•_.: ...._�a.::.r,,:!.±.�. Street <br />�ck No .................................•--- <br />Addition....................................:.............::............. <br />...................................�-•- <br />`i:i t . '� ; , ' <br />t�iemarks ................�.....i1.r.�......:.::::......._...:.`.:�_t_...............---.........._... <br />.•.C:�}..... J <br />AND MATERIAL USED <br />Lcad Connection Complete <br />Saddle Complete <br />S:rvice Cock <br />Scrvicc IIox <br />. � , . , . � ' � � , _ � . . <br />Superi."'...........:_ � <br />ntendent <br />'. ) <br />No. iiours I,abor ..............................................Cost.................................................... <br />Cut in..._ ............._Pavemenl....................X....... .............. ........................Sq. Ft. <br />....................X........................ �� <br />....... _ ............... <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />........................ <br />Total ........................Sq. Ft. <br />--- — <br />Rem a r k s ................... �............:....:................:............:.......:........... <br />...................... <br />OrderP.eceived .............................................................................................. <br />�Voric Cempleled...S.,.::.�..L ::...:........................i.l--..:.......:..:.._:....:.......- ! <br />� Fo�eman <br />