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r: <br />/ ��'.�',� � <br />w. o. ronw a ,� � _'�C'/,y <br />' ' CITY OF EVEFfE7 .� vJater. Dept. � <br />Application No..L.:?.:_ �.":.... Date........_:..`.:..-::..:.4:.:-......._.....19...... <br />Iastall .................. :...........inch water service pipe <br />For................................. ..............................................................•-- <br />� ............. <br />7� ,. , . <br />� /:r.......:�..__.,.<c: ✓. r..:..�.::�i<:...�-�. Street <br />On .......... _Y...... ... ....... <br />, ............ <br />Lot......................................... ................... Block N�....._----- --- <br />.9ddition ....... ..._ ......... ....... ......... <br />Remarks �/ti`"' ..........._..- �---....... <br />...............:.....:.. ...................... ..---...... <br />... ........... .... ............... .... . ................ ........ .. ........ ...... ........... <br />/J� �//�� <br />... . ........... .... . ..... . ... .. . ... .... .. ................................1.._�l.l..' -:�:..�:.i:II___ <br />Superintendent <br />— ..j//�f <br />LABOR AND MATERIAL USED <br />No. i Size I <br />Lead Connection Complete <br />Saddle Comp]ete <br />Service Cock <br />Scr-vice Box <br />No. Aours Labor ..............................................Cost............................................-------• <br />Cietin ....................Pavcair.nt....................X........................ ........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />........................ <br />....................X........................ ,: <br />........................ <br />Total ........................Sq. Ft. <br />— -----' _ — <br />Remarks.................................................................................... <br />Order <br />\Vork <br />............Fo remal�... <br />