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pq' � 11 `� ?�—1 <br /> w. o. ronH S' � � � <br /> ' CIT`�' C�F EVERE��`T--Water Dept. <br /> Applicatiou No_��>�..3 �.... Date..........'3...::.�........................19_�': -� <br /> lastall......._.........._..........:nch water;ervice pipe <br /> For ....����,_�........y.S.�:S�E.:!............. <br /> �` ............................................... <br /> On ......._.C�...�.?_�..�--l�.c?����.....� T..?.9_t`_......................... Street <br /> Lot..-- ..................................._................ Block No.........--.............---.....__ <br /> Adclition ............ ........................................ ........................................... <br /> Remarks .......��\�:.1.�:Kc��,..`:� '.:� <br /> .................................................... <br /> ....................................................................... ............................................. <br /> ............................................... �--� ................... � .....................-----....----....... <br /> .................... __.........................-•--..................................--..--.........._..............-�-- <br /> ........................................................................................................................ <br /> Superintendent <br /> LABOR ANL MATERiAL USED <br /> No. Size � <br /> —�—— — <br /> ............._.......................................I Lead Cmncetion Complete <br /> ...................................................... Siddle Complete <br /> .......................f t............................ ........................................................................Pi P e <br /> ...................................................... Servicc Cock <br /> ...................................................... Scrvice Box <br /> No. Aours I�aSor..............................................Cost................................................... <br /> Cutin........._.........Favement....................X........................ ......._-.............Sq.P't. <br /> ....................X........................ �� <br /> , ........................ <br /> ....................X........................ �� <br /> ........................ <br /> ....................X................--..._ �� <br /> ........................ <br /> To[al ............._.........Sq.Ft. <br /> --------------- ' <br /> Remarks............................................ ......................................... ................... <br /> ................................................................................................ <br /> .............................................................................................................:.. ....... <br /> OrderReceiced................................... ................................................. .. <br /> \Vork Completed.......................................................................................... <br /> Foreman <br /> � <br />