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� <br /> W. D. Form 4 I500 :f-1-I]C.P. <br /> � CITY OF �VCRCTT==Water Qepartment <br /> Application for Water <br /> All blanks must be filled in or crossed out <br /> L•'vrrelt... �_'. __'�____.__191 y�� <br /> TO 7'IiE SUPIiRIN1'ENUGN7'OI+'CIIE \VATER DGPARTniGN7', <br /> Cl7'Y OR G`JERGTT: <br /> 1 hereby aPPly for lhe use o(�caler in accordanee�vilh Ihe rules and regula- <br /> ti�w;u('Phc Water Uaparlm��nt, fur pivposcs and fisWres statccl below. <br /> DurinF [he [ime that any of the wator mains may be taken up by rcason of <br /> :my impmvemenis authnri>c<I bc th�•Cin� u( lircrett,in or nf miy streel ��r alle}' in <br /> �eh�ch theY�»�n' ha�•e bcen laid, the CitS' ��'ill not be requind lo lurnish o•atcr during <br /> the pmgress n(such improvements tu any consumer whnse suppl}• may �hus 6e cut <br /> nfL or be liabic (ur any dam:�ges fur its (ailure so to clu. <br /> Applicntion N ._�T-�l�-"'-'- <br /> 131nck ....�3._r_?__LoL_"'�' _ _ .. AdJ..__-_ ..__"__.__._... <br /> No.---�--� -�--�1___1t��5trcet <br /> ____' ___._._._""_ . ____"______ '_. ' <br /> '1'hcmrorklobec�ecutedby-_ ___.. _ "__________ _-.__.._____ Plum6er <br /> . Statc sizc ot lap. <br /> 1':�p to be insertcd in the ntain. �� D U G <br /> _____�_Wa[erdnsct <br /> - "_______linth <br /> ___. '___ .Urinal <br /> ____..____Piain faucetinsidc <br /> ._____"'_Sidc�valk �rashcr <br /> ""__'.._liosc bib uutside �\ <br /> _""'___.Ilose bib for 6uilding purpuses ' J <br /> _____"_.Hosc hi6 inside <br /> _"__'_"'f3i6(or stablc cuntaining______'.'__st:dl...'__'_" <br /> , __"..__"Nwnber of persuns in (amily . <br /> _____""'Num6er o(roams in building <br /> � ` . . ChePremisesnrotnbeusedasa__.._'_______."_..____""_____' ____.' <br /> • • . \�Thco�aneroftUcpremisesis ___'_'____"___._..__'_____'_____'______'_"" <br /> "I�III'i1�:L'�ll 1] ._..______'.__' ___._'......... .......'____.____..".___-,__"__'_ <br /> 'PLis applicatimL although signed, shall not bc Uinding upon thc City, n[il ao <br /> � ' hy The Superintendenl o�he Nnter DeparUnenL , <br /> SiNncd _i��J'-C-LuW-__ __ _._ �-'�',"_'__Applicn t <br /> ;.ccePte<t�r�.-_Q_2..191/ 13y_ .. � . _'_�_ <br /> !- <br /> ��""'�Suprrlmcndev -' <br />