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I <br />/A�-627 <br />0. FORM 3 <br />CITY OF EVERETT—Water Deot. <br />i":�an No........................1115(el t,!AR 1 1962 <br />' Date ............... . ........................ . ..... 19 ...... <br />Ins ... ...... .............. inch water service pipe <br />For <br />.. . ... .. ..... ....... <br />On Street <br />�q.�t .......... :rt". Block �'Z <br />Lot ...... ..... No..... <br />Addition .............................. <br />Remarks........................ ........----- <br />Superintendent <br />LABOR AND MATERIAL USED <br />Size I <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />.................... ........ *..** ...... * ............. <br />Order Received <br />WorkCompleted ...................................................................................... <br />Foreman <br />