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.- -�����` • �' / � <br />W. D: fORM ] 'S — ��� L.c�J <br />CITY OF EV�RLTT--Water Dept. <br />Application No..��..��'°:��... Date............^..::..� ........................19.�:f <br />Install ...............................inch water ser•�i�r. pipe <br />For............. ..............�..... ,f........,..................._...........................................-- <br />� "' .%/.•-.�5.....C.:....... ��:':�.c:�._ .......................................... Street <br />On .......... .. .. . r . <br />Lot...........- ................................................. Block No............--- --- - - - -- <br />Ad�lition <br />Remarks <br />........................................... ................................................................................ <br />Superintendent <br />LABOR AND MATERIAL USED <br />No. I Size <br />........................._i_.........................I Lcad Connection Complele <br />.......... ..........................................� Saddle Complete <br />.. � � ..-- - k <br />Setvice Cock <br />Service Box <br />No. Fiours Labor ..............................................Cost.................................................... <br />Cut in ....................Pavcment....................X........................ <br />........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />....... _ ............... <br />....................X........................ �� <br />• ........................ <br />Total ........................SG. Ft. <br />--- -- <br />Remarks ......................................................................... ........................... <br />OrderReceieed ............................................................................................... <br />\Vork Completed ............................................................................................ � <br />Foreman <br />