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I/ �F'_� ` <br /> r � �� � 7 _ <br /> � <br /> w. o. ronH <br /> � - CITY OF E`dEiZE i T--�7ater Depr.. <br /> -- � <br /> Application No.f..7./..�_7 Date.........._...._ �..........................19..1� <br /> y/l / �Install....././.�..�... ..-.y..�..... inch water service pipn <br /> I'or ..../,..L��LL:: .:LC.1.`...._..r.:2... '-L.c!:C:CI........_.. <br /> . . . <br /> ..................................... <br /> On ......_r��.�.G...J..._-....:.+�..'��: -.._ %:r`t��=.�............ 5treet , <br /> Lot..................................................... .... Elock Na................................---.. <br /> :1d�lition ........ ............................................................................................... <br /> Remarks .............................. . . ................... <br /> . .. ... <br /> ...... <br /> .....................�---........... <br /> ................_.............._.._... zt�z}r'�l�t.:. .:t.z?�..........................-�-.... <br /> r.. 7...... .......................................................................................................... <br /> ..�1 e..H�..�.✓................................................................�----�--��-�-�---�-��- <br /> ,,��.........-�.��......._._........................... ........_.. <br /> ......... .................. <br /> /O ` �/ � � / Superintendr,nt <br /> LABOR� AiVD MATERIAL DSED <br /> ___Na � Size � <br /> r <br /> ...._................................................I Lead Connection Complete <br /> ...................................................... Saddle Complete <br /> .......................f t............................ ........................................................................FiPe <br /> ...................................................... Scrvice Cock <br /> ' ...................................................... Service Box <br /> No. Hours Labor..............................................Cosl.................................................... <br /> Cutin....................Pavement...................:X........................ ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ ,� <br /> ........................ <br /> ....................X........................ ,� <br /> .......................� <br /> Total ........................Sq.Ft. <br /> _,_ _'__—______ <br /> Rema rks.......................... ................................................ ............................. <br /> .......................................................................................................... ...... ... <br /> ............ ........................................................................................................ ..... <br /> OrderReceived....................................... ................._.................................. <br /> �Vork Complefed............................................................................................ <br /> Foreman <br /> _ . �-� <br />