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s <br /> APPL. <br /> � <br /> No. y��� CITV OF EVERE?T eaoe�RE NO. <br /> A?PLICATION FOR WATER SERVICE j � �-� � - �' <br /> �FIXED DATE��__`�_�g,�_ <br /> � DEPOSIT S �(�LiL/' ��1 W. O. <br /> No. _ _ <br /> SERVICEfer�ooqeesl C�t�`E-__C�L--�%�-S{�JL��_BLK..--LUT�� ADD. '"'"`-'-�"�L�-% <br /> OWNEY�C�=_���L-T�I.�C�L _ _CONTRACTOR _ <br /> INSTALL 3� `AT ED SERYICE-_-_.___ � <br /> 1 HEREBY APPLY FOR TNE USE OF WATER IN ACCORD�NCE WITH THE <br /> OfiDINANCES ANO POLICIES OF THE 1VATER DEPARTMENT NOW EXISTING �: �0�.�/� �q /��� i <br /> OR AS SAME MAY BE HEREAFTER CHANGED, eiGHEo: �C 1V1Sc`^� L_�L�-��___ ___ � <br /> MAiERIAL6 li IN.I � �ti� I� N' I �'A�GE AMOUNT <br /> P�PE COPPE GALV.•- STEEL ,�� �I I <br /> __—�---.-_ --{ <br /> CORPORATION / I � <br /> URB GOCK OT__ _ / I I— — <br /> SERVICE BOX LASTIC -_C I_ I - - <br /> METER VALVE <br /> METER No.__—_—.�-_. -. .—TYPE—_--._-___ ( ,� — ._--- __ — —.- <br /> � METER BOX CONCRE7E SMALL LARGE <br /> �����.���[.t�j.+�_�RQ�i�__ _�—I --_I— _— — i <br /> I I _ <br /> _ _—I — �1_ _"'_ __ <br /> __'—__"_'-- ' _ - I—I �_ '_-__ — _ <br /> i i � I� <br /> I �` ON <br /> DATE INSTALLED: /�_�,g_ ,) � � OFF Sl1B TOTAL <br /> CODE I IABOq ANDEOUIPMENTqENTAL I HOURS R�TE <br /> � o I �F <br /> _� --- ��J�---- --� 4 <br /> � f �,� ra�y—I — - -- <br /> _ _- ----l:*�-! /-- ----��f-- -- <br /> � <br /> -- _�� 2 _ �-I--- -I - - <br /> _� --- _ �_ -- _ <br /> TOTAL <br /> REMARKS: �l � . / `� � . . � , . <br /> . n �. � /� ��i .o. . . . <br /> � . . <br /> '___' '- -_�._:, : __�__...__._. __ ' __'_'-1..'-_�' � .—�_ <br />�� <br />