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/�'d G � ���� , <br /> w• �. ronu w ✓ <br /> CITY OF EVERE=TT--Water Dept. <br /> Application No�..�`��.�.7.. Date........:� _�........................._19_� � <br /> lnst/al ...........................inch water service pipe <br /> F�r ....i�r.a.s�:.........fY. _: �.^�a.7 ��................................................... <br /> � /, • <br /> On ..... ._�c`Hr.s?........_4:..N._s�.:rr.s,:.�ti.�(.................................. Street <br /> Lot.._Z%'.:�5.�.....�P.l'.:�_'�!./7.!�. Block No..................................... <br /> Adclition .......................................................................................................... <br /> Pemarks ............................. . . . . . .......c�.. . . . <br /> � - - <br /> ...... ...... <br /> .........._....................................: ..:l.An:xfy,.tt.'_".....k'.............................'_........ <br /> ...................................................................... ..................................................."' <br /> ......................................................................_ ................ ..._........._................... <br /> ............................................................................................................................ <br /> Superintendent <br /> L9BOR AND MATF.RIAL DSED <br /> No. ' Size � <br /> .... .............................__...........� :.cad Connection Complete <br /> ......................................................� Saddle Complelc <br /> .......................f t........................... ........................................................................P iPc <br /> ............ ....................................... Scrvice Cock <br /> ................................. ................... Scr�icc Box <br /> ...........................�.......................... _............................................................................................................... <br /> No. Hoiu�s L�bor............................................Cost.................................................... <br /> Cutin....................Pavemcnt....................X........................ ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................Y........................ ........................ �� <br /> ....................X........................ �� <br /> ........................ <br /> Total ........................Sq.Ft. <br /> --- ---- ---- <br /> Re�n a r ks............................................................................................................. <br /> Order.Recei��ed..�_...._.._...............�............_._........._.�.................._....� <br /> \ <br /> \Vork Completed..................................................... ..................................... <br /> Foreman <br />