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/-.,�c L-G <br />'N. D. Form 4 <br />CITY OF EVERETT—WATER DEPARTMENT <br />APPL�C;ATIQ�N� FOR �ATER <br />Ali blanks must be :i:•led in or cro=sed out <br />. - ' i _/ <br />hverett, ........ .._......%...'.�'.2.�,:.a.t....�.:si ...................ls: �:...... <br />TO THE SUPERIN'1'cNDENT UF .4E W.1TER DEY.9RTn4�NT: <br />C?'CY UF "'�VL•RETT: <br />S h=_reby apply tor +'ie usc of v;atzr in �ccor�iance wlth the r��les snd regu- <br />lations o' the V7ater Departm^nt, for purpr,ses anfl iistu: es stated belo�v. <br />During the time tha? any n; ;Ir_ :•�: h+r tnatns rna; Ue taken up by .=ason <br />of any improvements authorize�i ov �hc t.;it� o: ":ar���;t, i:. rr n' any Street or <br />allcy in which they may haae bcen ia;:i. ��,-. !'�� ' nu�: l;u requi:ed to turnish <br />water during the progrr.ss of sueli tm�ren : � in :.ny cnnsumer mhose sup- <br />ply may thus be .ut off, or be liable f�m �.:., u,:ma^,es :or ;ts fsilure so to do. <br />� <br />Applic2rion No.....���/...r�..,.'�:........ <br />Slock..................__._............... Lot..............._......_............... Add..__....._.............. <br />No......_...._J-.�-i]— �,��,t«<_�.. ......_...Strect <br />.... ............. ..... . . ...... ............................. <br />Tf�e wcrk to be executed by... ..._........._... <br />Staje�size of tap. <br />./ ...Tap to be inserted in the main. <br />................Water closet <br />....�i .:......Bath <br />................Urinal <br />................Plain faucet in;idc <br />................Side walk waslicr <br />................Hose bib oulside <br />Plumber <br />�,�, n,G� <br />,,r' �� � �,�; �; �� I� <br />N . I <br />................Hose bib for building purposes �+t�e rC ���� <br />L��:,,.,..; . <br />................B b for`st ble contaming...................st��Tr�-f���F; � � <br />................ ' all.................:.. � . .;� <br />......../........Number of persons in family <br />......(�......Number of rooms in buildiug <br />The premises aze to be used as a ................................_............................ <br />P Y P P �c _ � .......... ...... ......... . . <br />PP —�� <br />acceTt d b ethe,5u crinte den..'...the R .........:..................... �P. <br />ie owner o ie remises i......... ............ <br />g. . . . ...... ..... <br />This a lication, althou s� d s iall not\bind' u on the ( <br />'atcr Depart� t- <br />Signed..... <br />until <br />Accepted....._..__ .............._._...._........19...__ By........_.__........._.............................� <br />Supec•intendent. <br />