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� <br /> APPL. 1 �� /�„ AP�LICA710N FOR SERVICE SERVICE N� 3 4 4 <br /> No. �� Ls ;� ORUER <br /> �j(�� CITY OF FVCRETT WATER DEPT. / <br /> �' FIXED <br /> � DATE /� � �Ifl'� <br /> � OEPOSIT �� <br /> 5 ���. \ i. W. O. <br /> t !!% c <br /> /J / j ��' <br /> �( .� ,�jll-rlC-I ,���. pLK._ LOT �L) eDD. � <br /> SERVICE ( ADORE681 /- <br /> i <br /> OWNER �� I��-�L�c_�_Z�. �C- llC�t�� _-; �' _CONTRAGTOfz- <br /> �.��� FLAT � <br /> INSTAU 1�7'LFiSD-SERVICF —__— �/,��, <br /> 1 HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCF WITH THE �'/(�,` /i��� .�.:./�� // <br /> ORDINANCES AND POLICIES OF THE Wl.TER DEPARTMENT N01Y E%ISTING � /Z�/ I /,/GL- LV <br /> OR AS SAME MAY BE HEFEAFTER CHANGFO. slc,rueo: X �^� j( <br /> MAT[RI�LS ___ l.. IN. 1 IK. I 21N. I PRICE AMOUNT <br /> I �PIPE � CO P R-'r c'�LV..- 3TEEL �,+J I I �� � I <br /> —" '.___. — � �, <br /> CORPORAT�ON _ _JI�'/ _ <br /> CURB GOCK . ��OT / I JI 'T _ <br /> SERVICE BOX LASTIG --- C I I � �_ <br /> METER VAWE __ _ _ — ----_— _ — � <br /> METER IJo. TYPE: I S5 <br /> METER BOX CONGRETE SMALL LARGE I <br /> _i <br />- , 4a�f,�- z I /� �i � I� <br /> � .� o° � �3. <br /> — I <br /> I I <br /> I <br /> I I <br /> � ON <br /> DAl'E INSTALLED: 7 � .7 I �-OFF � ! - SUB TOTAL (�'7 2/ <br /> �'� / /I .JG <br /> CO�[ I LAUDR AN�EOUIP:dENTR[NTAL � � HOURS flATE <br /> I � �� _ � �� �� � % - _ <br /> � � -- i �� ' � ,� � <br /> I � '�- : ; ; I � I c; i v-, <br /> �, � � <br /> ; i I'� I <br /> - i- - - ------- - � --��L -L-- <br /> II TOTAL I���� <br /> REMARKS: �i � , � <br /> � �.c� _./�-a.` .,-._.- /� __— _' —_--_ � <br /> _ _T2.1�1-. ------✓----- ----- S' <br />