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S.1.hirMnN7-1629G3'�51 J �t� 1.�+ � \ <br /> W.D.Forra) <br /> CITY ON' EVEREIT.�VUater D t. <br /> A , �' -7 -' <br /> PPlication Ao....,r.1....l...:�.... Date.............._ .. `> / '" � � <br /> t � <br /> .............................19...�.. i <br /> Insta]I........,!, �',Y inch water service pipe <br /> r... ............. <br /> For .............. <br /> . ..............-----...............:1... <br /> � .................................."'.................."" <br /> On ..............._��.�.........4z.........:::K........ ........:....... <br /> 0 "f t ��.-: _c�, <br /> �' /.. Street <br /> .................. <br /> ot............... .,�..`.�........................... Block 7 � <br /> ......... . <br /> Addition � ""•' <br /> -.� ......._........... <br /> .............. .....---........................................ <br /> - <br /> ....... <br /> � -- _/�� �.............................. <br /> Remarks ......_1�_..5... ,t ._�--�. f�— • v <br /> . <br /> , r........... �.:�.......:- `�. < '% /, <br /> ......._....... <br /> ..........................._ . , <br /> ..................................._:.......................................................' ' <br /> ..................................................................................................�........................ <br /> .................................................................�--............ <br /> .................... � .. .....; . <br /> ....... <br /> ...................................... � � <br /> ..................... <br /> .................. .....::.. .:...._«.� �:_L. <br /> uperip`/Qndent <br /> "� / / <br /> LABOR qND MATERIAL pBED <br /> _ No. Size <br /> `�"""""""""""�� �---���- Lead Connection Complete <br /> ...................................................... gaddle Complete <br /> .......................f t........................... <br /> . ......................................................................Pipe <br /> ..................................................... Scrvice Cock <br /> ...................................................... Servicc Box <br /> .......................................... <br /> � ............._.......................... <br /> No. Iiours Labar...................................:. <br /> Cut in....................Pavement.............. .........Cost.................................................... <br /> ......X........................ ........................Sq.Ft. <br /> ....................X........................ <br /> ....................... �� <br /> ....................X........................ <br /> ........................ �� <br /> ....................X........................ <br /> ........................ �� <br /> - ____ Total <br /> __—�--:—�—___.--�:__—...........__...Sq.Ft. <br /> ftemarks....�,!�r,,1- �� .:% ,i L -- _ <br /> ..........,/.. .............s....�:.::.: <br /> � � � <br /> �y�:�-,,�_._..,,�-- <br /> ....................................r.- ° <br /> ....................... <br /> .......................... . ....................................... <br /> ..........._..................................................................................... <br /> OrderReceieed.............................................................................................�, <br /> \Vork Completed............................. <br /> .......... <br /> ...__........_... ......... . <br /> Rorem�n <br /> �,.c . <br />