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� <br /> S 1•VrieLe�M].4b 29355 O��O <br /> W.U.Form 3 ' <br /> CITY OF 1: ERETT--Wa.ter Dept. <br /> `?" ' `% -l/ <br /> Applir.ation No..�c-./l:. �ate...ffl/.'f..'!7...�...y....19.�l.%'. J— <br /> ,Install.................. ...........inch water service pipe <br /> � �._��-. <br /> ,�ar? ............./.f�`.....,�...��.:......._�:::.�.:...._......--...........--............. <br /> � 'Od?. �li`�/�l���l�....�..... ///� r-1��..� _ -- <br /> � ..�r .... 1......._<_/... _..C.�.s.`"/.�:l8treet <br /> Lot..................................... ........................ Black No.......... .---............._.----�-• <br /> Addition ........................................... <br /> '� ......................................................... <br /> Remarks ....................................................... <br /> ................................................... <br /> ......................._............----�---......_......................................................--------..... <br /> ......................................................................................................................... <br /> ....................................................................................................................... <br /> ................................................... <br /> .........................._................. � <br /> ...............-------- <br /> � Superintendent � <br /> LABOR AND MATERIAL USED . � <br /> _No. Size � <br /> � ............................... .................I Lead Connection Complete <br /> ........_........................................... Saddlc Complete <br /> � .......................ft._....---..................I ......................................................................Pipc <br /> .__.................. .................... Service Cock <br /> ....... ... <br /> � � � '--..._..............................................I Scrvice Box <br /> ................_.................................... ..._........... <br /> ........................................... <br /> _ ...................�� <br /> ........ <br /> No. Hom�s Labor................. ............................Cost.............. ,�.y�. <br /> ..................................... <br /> Cut in..........._.......Pavemet.t...................�{......._............... ..............Sq.Ft. <br /> .......... ,.,.� <br /> ....................X........................ ,� <br /> ........................ <br /> ;�. <br /> -..................X.........._............ ,� . <br /> ........................ <br /> ....................A........................ �� <br /> ........................ <br /> 'Cotul ................._ Sq.Ft. <br /> ��- ---- —�-- -. <br /> , <br /> �emar s............................... <br /> .............................................................................. <br /> .................................................................................................................... <br /> ..................................................................................................................... <br /> OrderReceived...... ......................._............................................................. <br /> Cdork Completed............._........................._ / <br /> .................................. ............... <br /> Foremar. <br /> a, t-� <br /> ,�' <br /> � a�; <br /> ,�` <br /> :'"' <br />