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, <br /> d-,.. , . ..� r „� . _-- , _ <br /> , .r <br /> W. D. Fonn 4 IS00 J-i-IYG.P. <br /> G�TY �F EVC:RETT==Vl�ater Department <br /> Applicatior� foa� W ter <br /> NI blauks must be filicd in or crossed u <br /> �.,.�««..�-�-�� ----- --,�z-� <br /> TO 7'I�iG SUPI3RIN'1'GNDL'N'P OP THE NA'CEIt UL'PAItTMfiNT, <br /> CI'I'l' OF�E`JERfi7'T: � <br /> 1 hereby apply Cor the u:;e of water in :¢cordarce n�ith Ihe rules and regula� <br /> tiuns u(Ti�e lVater Dtpnrtm�nt, (or purposes anJ fixtures stated belaw• <br /> Durinq the time tha[ any nf thr wa[er mains may be taken up by rcason of � <br /> any im9rovrments auUmriz��d by the Cilc uf C�crett, in ur of am� strcet or alley in <br /> which[hey nn+Y have becr laid, thc CitY «'ill not be rcyuired to (urnish water durin� <br /> the progmss of such imp:ovaments- tu any eonsumer whnse supply may Ihus be cu[ <br /> oi(, or he liablc for any<IamaKes lor its (n9ure so to du. <br /> Applicnlio�N�/ __'_ �-- � � � � <br /> �s° y --�= <br /> rti���,� - - / ��--- ° — 3 I naa ---- --------- <br /> -- -- - <br /> � <br /> bo.__, � � Oc) �/7- ___._.___- '_ .Street <br /> __ _____ _ __ _ ___"'. ____'. .__ ' <br /> '__'.. _'__-'_-'""_ ' ___"____ ______'_'___'"_""__"'"'_'"'__. <br /> '1'he work tu be executed by---------------------'------- Plumber <br /> ��tJ <br /> � .SI.ICC. ZB O�l0)). � <br /> \,. 1�J <br /> ___��_"Pap [o be inserted in the main. — <br /> __.�____Wnterelaset � <br /> ___'1___.13.�th . �., <br /> .Urinal . ., . �,� <br /> ___ _._ . . . . ; f: <br /> ___Plain taucet inside � . ' <br /> _.. _____ Sidc wallc washcr � ��} <br /> .__"_.._Ilose bib aalside '�.. ...� <br /> ' ._Hose l�ib far building D��rpuses <br /> ______ _._ ''I <br /> ______Hosc bib inside i � <br /> .__�1ib (orstablecontainin ___stall__.____'_ �) <br /> _""- 8-____.__. <br /> __.._____Numucrof persons in family <br /> ____�._._Number o(rooms in buildinq <br /> 'Chu premises are to be used as a'___' ___" '__"'___"'_" """' <br /> 'Che nwner of t:ie Premises is __'__...._______.______________________"____' <br /> "1'hea�;en[ is__________.__. _______________ _____ __ ________'__. .._._'____'__ <br /> 'Phis appiication,althouHh signed. shall nat bc bindinq upon thc Ci.y, until ac <br /> cepted by The Superinten�d�e�V/,o�t �c 1Vurer Depa�rv1 n��nt. �(yq�� <br /> Sil;ncd !__ _ ��./- ! �L`�' 1 "_;_-____ApFlicant <br /> v_✓ <br /> C� ��� ^- - � --- — -- <br /> n«��>«a . . ---- -- �st n�- - - - -- - - ---------- <br /> � s��,�r�«�a��� <br /> � <br />