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// •��" �+�' ., 4, tf <br /> w. o. row�• a . � - ,- [ _ .. <br /> � CITY CF �JERE?"I- ���'ater Dept. <br /> Application A'o..�.�� ti.::,::.:'.:. Bate........_ . :i.:.:%...:.�:.:�...........19...... <br /> 1ns:a11...................... ....... inch water service pipe <br /> For .................................................................................................................... <br /> . . . , <br /> j � , ,, iL /��; <br /> On ' ' • <br /> ....................�...:.:..z1t:..........1.:.::..,:�...�__..........<:.:./..:�............ Street <br /> ` �, <br /> Lot............................................................. Ei„�ck No..................................... <br /> Addition ................................................................................. ................... .... <br /> Remarks ................................................................................................ . .... <br /> ................i_:��N�`:.....---.................................................................................. <br /> .......................................................................................................................... <br /> _ ......... .................................................................._............;.•�':._..Y..�........:.! <br /> Superintendent/ <br /> i i,� <br /> LABOR AND 11fATF.RIAL L'SED <br /> No. � Sizc � <br /> -- '�j�--- -- <br /> ......................................................I Lead Connection ComPl:te <br /> ......................................................� Saddlc Completc <br /> ......................ft._......................... ........................................................................Pipe <br /> ...................................................... Scrvice Cack <br /> .............._............................,......... Sercice Box <br /> No. Hours Labor..............................................Cost.................................................... <br /> Cut in....................Pavement............... X........................ . q.Ft. <br /> ..... ....................... <br /> ....................X........................ �, <br /> ......._.............. <br /> ....................X........................ �, <br /> ........................ <br /> ....................X........................ �� <br /> ........................ <br /> Tot�l ........................Sq.Ft. <br /> --- — — <br /> Remarks............................................................................................................. <br /> ........................................................................................................................ <br /> ............................................................................................................................. <br /> OrderReceived............................................................................................... I <br /> \Vork Completed............................................................................................ <br /> Foreman <br />