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S_ <br />>v. �L Farm e � . �o(, <br />CI p EVERET�I'---Water Dept. <br />QP� ER <br />. ,, ._ <br />Application No ......................... Datc..../..�..:..'..........:.....::�....`:.......19----::.. :. <br />Insr,dl.........:: �.._....,....inch water scrvice pipc <br />� <br />For 1........ . <br />............................................. . ..........................................-�---' <br />1 / __r............ <br />.y f , — ' .'.: � _ <br />, <br />OR ........`�.L..! ..........:..:.........:.:�::'...::.......�...�.::....._...........................$tCCCt <br />Lot.................................... .................... Block N <br />Addition ......... <br />Remark�s �........................................._, <br />(/�1-! . , -/ / '�i>- ��., <br />.......................................................................................... .....�...""'..:................ <br />,�-�. �. -�.i <br />,., . . . �,l , �� <br />, � <br />........... _-""'......:.:._ .:....:...:....... i........................:.,...:.... ..... <br />' � .�i � 6upednlendent <br />/ 1= � <:� / � . <br />j�Y . �. . . ,.t.= <br />LABOR AMD MATERIAI. USED <br />........._ Lcad Cunntttiun Complete <br />........._ Eaddlc Compictc <br />i. � / . <br />........... ....L..F: f� � S.:!:.................................._Pipc <br />............ Scrvicc Cuck <br />............ Sncrvicc Doxn 7 �o }� —( <br />............ .l.`:1?.s.a-liY..4:x.t :!f....._ �,�...dF!.... �!....._S:'..�l................................._.. <br />� � <br />No. Hours Labor ........................................Cest................................................................ <br />Cutin ........................Pavcmcnt....................X.......................... ........................Sq. Ft. <br />...X .......................... .. <br />................. ........................ <br />' ....................X.......................... ........................ .. <br />, ��.�"" <br />�yt� ....................x......_................. .. <br />�?�� <br />Tutal ........................Sq. Ft. <br />Ordcr Rcccivcd ..................._-.. <br />W"ork Complctcd .................... <br />...................................._............""--................ / <br />Fo.���,.,� <br />