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/�7�9 ° <br />W. O. FOPM 0 '� <br />Acct. No.... ..-...u4�.��..f.... <br />CITY OF EVEREiT—Watcr Dept. <br />Application A'o... / �..1L':.�L .... Datc........,=-�....:1.....L.: !,� .................19........ <br />Install ................................ inch water service pipe . <br />Owner ......... ............................................ ...................................................... <br />< .............. <br />- <br />Address..............._�:.1...l1...aZ..........: �11�_;C.�c_:.c.................................................. <br />r.�t -- - '- ..........IIlock No ................................................ <br />Contr�ctor.. <br />c. <br />Shop <br />........ Rec. No............_......_......_ ............ ._....................... <br />� � � <br />]c_ .r <br />sy.....__ .................................._.....�' �1.....�.:......4..... <br />S p�intendcnt � <br />���" <br />.............................................................. <br />........................................................... .. <br />�Vork Completed ............. <br />.Foreman � <br />