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��-,�,�j''� ���, i <br /> w. ;. ronM„. <br /> CITY OF EVERLTT--VG'ater Dept. <br /> Application No.l...1'�!'....�. ...3 Date..........�:..l.�.........................19..(c.t � <br /> �J / 7nsta1l.......... . ..........inch water service pipe <br /> ...../.. <br /> For ....._l.C/cs;:/...:z:�.L:............ ... (.:�f:k�.......... . . ............. <br /> ���,� �. ; J` <br /> On ..............._lJ. ....r—rx.,r...�=-_:..._1r.l..:-�'t.!.���:ba:4c�............... Street <br /> LoL..302.� ��_�5f..a:.��a... Block No...........................------- <br /> :1d�lition .......................................................................................................... <br /> Pemarks ........................../... .. .. . ... . ... . . <br /> y� ... . ....� :......................�---............. <br /> .............................................5.:��ca:1.S31...2.: < .h.?!............................------- <br /> . .............................................................................................................................. <br /> .............................................................."'........................"'............._................... <br /> ....................... ...............................................................................................""" <br /> Superintendent <br /> LABOR AND MATERIAL USED <br /> No. � Size I . <br /> -- —i—--- <br /> ...........................�..........................I :.ead Connection Cmnplete <br /> ...................................................... <br /> S�ddle Complete <br /> .......................it........................... ... ..................................................................Pip.. <br /> ...................................................... ..�rvicc Cock <br /> ...................................................... Scrvice Box <br /> N��. I-Iours Labor..............................................Cnst.................................................. <br /> Cutin............__....Pavement...................X........................ ........................S9.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X....................... ,� <br /> ........................ <br /> ....................X........................ �� <br /> ........................ <br /> Total ........................Sy.Ft. <br /> ------ <br /> Re�na rks............................................................................................................. <br /> ................................................................................... . ...................... ......... <br /> .... ....................................................................................................................... <br /> Ora�r Receiced............ ........................................................................ ...... <br /> \Vork Completed...................... .................................................................. . <br /> Foreman <br /> :i�ti <br /> 'TSc: <br />