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r_"� irn �-� - rs- L � � <br /> E.�D t�-�x-_>;+a1 <br /> 0.'. D. Fcrm 4 I500 J-1-17 C.P. .. ` <br /> CfTY OF E1'ERCTT�=�1�ater Department <br /> �pplicati�n fo�r Water <br /> �lll Llnnks must 6c fil!ed in or crossed out <br /> L•'ccren.._._____._ ____/,/�.P.____...__-11��__ <br /> "P(1 7'tiE?SUPI:RWTL•'�UGN"I'OF'PFiE W.\7'Hi:DEPARTn1F.'NT, <br /> Q'FS'UF L"/ERETT: <br /> I hereb^apply for the use u!water in accordance�vith tlie rules.md regul�� <br /> tlons nf The 1��a[er DePartm�nt. fur purposes and fixtures stated bclo�v. <br /> Durins: [he time ihat any n(the�vater mains may bc taken up by rea�on oi <br /> :�ity intpruvemcn[s autUnrized by the City u(Greret[,in nr nf an}' strcet �rt aGey in <br /> which thev may have been I:�id, tlic City will noe he requimd tu lumisl� x�ater during <br /> �he prugrecs uf such imprnvemenlc (n any consumer who=_e suppl}' maY tims be cut <br /> ul(. ur be liable for anY�:��»fo;��fo{r'ies failure so lo do. <br /> � APplicnlion No..___'�'a `r('."'_" <br /> isi���x z-z-S— -- i�c- ---� ' �---- -- - nae - <br /> -- - -- - -- -- <br /> �o.—����-�—�'�-�-'��------------------.scre�i <br /> ' ----� ---�-� �--'-- � --'----"------------------'-'------�---.._. <br /> '1'he �curklobeexecutedby____ _________ _ __ _________..________ Plumber <br /> Stulc cize af tap. .{ <br /> . /Y"'Tap[u be inser�ed in the main. }0 <br /> �� •• � oG <br /> -_--f_–R'aterduset � _. �i5 _ <br /> --..�___.I3atli <br /> -__-___ .Urinal <br /> -.-.�____Plain (auret insidc <br /> _ _. ____Sidc�valk washcr . . <br /> -.-_-_�"Hos'e bib outside � <br /> -____C__.Fluse bib forbuilding purpnses (;. . <br /> '"'__'_'Hosc bib inside �%.�rr-._. <br /> _____'_._.I3ibfm'stablecontaining-.____.--.sLdl_ . !._._ <br /> _'_./..__.Numbcru(persuns in (amil�. <br /> '_"Io."..iiumber of rnnrc,s in 6uildinq / // <br /> "PhepremisesaretobcusedasaD.__._/_�___ l//J� � C✓_._--._.-__ ___. <br /> The owner ut the premises is � �–C ' " ✓ L ' <br /> ' l"___'�'L,Cc.c_v't_?–�""_'_____.. <br /> 'fhc agent is � <br /> '_'_'_'________"""_'-�_' _ <br /> 'Chis application. although signed,shall nnt bc binJinq upon the �ty, unNl ae- <br /> _eptrd by The Superinten t of lh�e"1Vn r llepyirtmrnt. <br /> Si1;n�"'�\�_ V �6_'_'__�� �nt <br /> _ ' """ � <br /> Aa;rpted_.–�--�'----------�� �, BY------------'------'-�--------� <br /> su;-r,�non�sm <br />