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- - 16 f VA43 <br />w. D. room 3 <br />CITY OF EVEREITMater Dept. <br />Application No ../ Date........... . <br />.......................19.1.Y <br />Install ...............................inch water service pipe <br />For ....... Street <br />On...... — <br />------- .... Block No .................. I .................. <br />Addition <br />Remarks <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />Superintendent <br />OrderReceived ............................................... *-,* ...... ................... <br />Work Completed ............................................................... <br />............................................. * ...... ...........................Fore <br />or a rn ..... a . n V <br />