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E' �r:--:� y. _ � c, _. <br />\V. D. F'crm ♦ IS00 3-I-17 C. P. <br />CiTV OF EVCRCTT==1�Vate!�� flepartment <br />�pplicataon foa� Water <br />All blanl<s must be filled in or crosse�i �m[ <br />e,����u. - —�f/ � �— —. i� 3 <br />�ro ri�r suri:��ic.rr�uen•r or �rin: w.��ri:a in:i�:vzTnu.�•r. <br />CI"17 Of L7ERE'PT: <br />I herehl' apply (nr the use o( water in accordance wi[h the rules and : eF,'-�la� <br />tln�i: uf 1'he q's[er U�P�rUn •nt, .`or purpuses nnd fixtures staled bclo�v. <br />During Lm time tha::my oi Ihe wa[.•r mains m�iy be taken up by re:+s�m uf <br />nny imprnvements autUorized bp tiie City o( L'vcretl, in or n( any sircet nr aIIcY in <br />�chi.•h tl�ey nnY have been laid. thi� Ci!y wili not be required 10 (uroish �eater �lurin�; <br />ihr prctqre:s nf such imprn��ements m nny rnnsumer whnse supply may [hus Le cin <br />„it. ��� be liablu tor anY ��-:y�:��=�'lcQs [or its Liilivc so to do. <br />:lpplicnti�,n qNo.'__'{�� .¢_�______ <br />I;li�cl: /�%_ / _' . I.oLs��"_�Z L �_AdJ_""' _______'_.__ <br />/__ _ /I � �____ <br />\o...-_`��.5.. _s�-07ZLV.ACL-�_..5[recl <br />.._'__.'_"' '_-"' ' ___ "__'___ -_"____"'_'_"'_'___"___'__'_"_'__. <br />"I�he �vu�.R to be esecuted by..___._ ___"__ _.___""_______ Plumber <br />titatc sizc of [ap. � <br />__�/�ye.Tap to be inserted in the ntain. �_ /<— or. <br />v <br />'".""""___'�i�nte� dosel <br />___._____Ii:dh <br />___. __._ .Urinal <br />. _ __ __ _ _Plain faurel insidc <br />. _ __ _ __"Sidc walk washer , <br />_. _ _.._Huse bib aulside <br />�: j � <br />_ ___ __.. _ _Hosc bib iur building purpnscs <br />. . . _ _ _ _' Hosc bib inside <br />_ __ __' _ ___Ilib (or s[able contniuing__ _ _ ___ __ s[aIL_ __ .__.. _ <br />___'/ __.Numhero[personsinfamily <br />_ `]'__.__Num6cr o( rooms in building <br />/ <br />The�remisesaretobeusedasa________ ___________.._______..___ .__._. <br />'1'h! ��r4ucro([hepremisesis _____'_______________________________________ <br />"Chc a�;ent is____'_____..._.__________'___ ..__-_____________________ <br />This :ipplicaliun, althou�;h xigned, sh:Jl not be binding upon the CitY, until :io <br />pt:•d by "Che Superin�enden[ ut�e Wnter �epartment. <br />\ � <br />Si�;ned ___ �J�_ -�---- - -'. Apphcant <br />:Arr:pled_�.r'� 1�.2 Ky__. _'_ _' - <br />-____. __._ <br />_ __. <br />_ _ ____ s��I�erlmenSr. <br />