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l <br />r✓ <br />S J. Priebc 47. ].4i�LFs� �. <br />W. U. Form l <br />CIT � E ERETT--Water Dept. <br />Application No....._...' ............. Date......- - ..........---......... -- ..19. -- <br />Install........r.::._.._ .............inch ���ater service pipe <br />For........................... ...........................- �-�` - - ............--..:......... ............. <br />.............::: :... : , <br />On � ......._'_ ..........:.:.......:.:........:._ ----.::!`-�-....... Street <br />Lot.... .............. - .......--�-� - ................ Block No.........._-----.........---..... <br />Addition.............................._.. ......_ ..._.....;.:............................. ...... <br />� ,_- <br />Remarks- ...............-.....---.:..�'....'..: -�.:._...._.:............................__.......--........ <br />�I..L .(..�':�. �.._ <br />��.'.-.�..�..` .1�... <br />i� <br />LABOR AND DIATER[�1L USF.D <br />S:ze <br />................_...��, icad Connection Cori�pletc <br />....._......_......' Saddl� Complete <br />� • <br />..._ ..............� .....:....:.�._._.......__..................... <br />.............. <br />i Service Cock <br />I <br />.................... Servse Box <br />ilo. Hours La6or...._ ........................._.............Cust............ <br />Cut in ....................?avecient....................X__......._......_... <br />....................X........................ <br />Superintendent <br />........................Sq. Ft. <br />........................ �, <br />........................ .� <br />....... _...Total .......... <br />........................Sq. Ft. <br />---- -- <br />Rem:;rk� .............................................................................................. .......... <br />OrderRecciaed... ---- ....................................d•-._....--.................... <br />\'; erk Compleled..rfsf d./. f.f1;!..........._......:.. T�e `; ``. ..... _.. <br />..........................Forem an <br />