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'` � ,�J /fr � �/P + ' n �v <br />, <br />w. o. ronw 3 �'� 7�' <br />� CIi :' OP EVERETI'--WatPr D�pt. <br />l ��•� 9 3- i= c�.........._.......�s.----- <br />Application No........' ...:.......... Date......._:...... ---......... <br />Iastall ...............................inch water service pipe <br />For..... ..............�......................._.........................................................-� <br />/ J ' <br />On ..........�X".�...✓'.......%.1C.G?.:<<':.:t::::.d:c:t :.........................._......... Street <br />iot............................._--............------....--- Block No...........-------................... <br />Addition <br />Remarks <br />No. <br />LASOR AND MATERIAL <br />Lead Connection Complete <br />Saddlc Complete <br />............. . ....................... <br />....._...... Service Cock <br />...:......... Service Box <br />No. Hours Labor ..............................................Cost.......................----...........--'........... <br />Cutin ....................Pavetticnt....................X........................ ........................Sq. Ft. <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />........................ <br />v �� <br />Total ................. ......Sq. Ft. <br />L1C11�Q1 RJ .................................................................... <br />ti � � � <br />— � r �< - �` ......_�,,._- <br />..._.........""""" .................:. ........ :�.. . ...:.G.._.... <br />G> " S i; J _I j J_ ... <br />OrderReceived ................................... .............................................. .......... <br />\Vork Completed ....................... � ............................................................. <br />Forem <br />