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�' :. . J �� �` � i \ <br />13 Z5? ' <br />B. J, pql[BE ]M --- <br />w. O. IOPM � <br />CITY OF EVERE'IT--Water Dept. <br />•�a =� _ <br />.iur, �� t.;�, <br />A;:,�lication No......:;}�;,.`.�.. Date ................................................19...... <br />Iastali ...............................i�ich water service pipe <br />For................................................................................................................... <br />Gn .....:�...�..�..-2_.._.,ir:•;:.:��:�:.:::L4:f:C% ....................... Street <br />Lot.............................................................. P,lock No................---.................. <br />F_dciition ............................ �-�--.....--�-....._....................................................... <br />Remarks........:......... ..........................................�---................._ <br />..................... <br />............. _-----.... _... <br />Superintendeat <br />� LABOR AND MATERIAL USED <br />Lead Connection .^,omplete <br />Snddlc Complete <br />........ ......................... <br />..... Servicc Cock <br />..... Service Box <br />No. Hours Labor ..............................................Cost.................................................... <br />Cutin ....................Favement....................X........................ ........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ „ <br />........................ <br />Y u <br />Total ........................Sq. Ft. <br />--------- --- <br />Re m a rks ...... ........................:................................ ............................................ <br />......................................................................................... .......... ... ................ <br />OrderRecei��ed .............................................................................. ..... ....... <br />\Vark Completed .............................................................................:.:.. ... <br />Forema <br />