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1 <br />W. D. Form 3 MOD 3-1-17 C. P. �- I <br />01TV O F EV E REi Ti ==b; ater Dept. <br />PP ]91� <br />A licationNo...%__P �_✓�_ Date_______ <br />v h s 1L__4 i1 _ mch water service pipe <br />rol------- <br />On ------ �:I_J4,:2..8___ _ Street <br />Lot._-/No.__SZ---- <br />Addition------------------ --------------------- ----------- <br />Remarks----- ------------------ --------------------------- <br />------------------- ----------------- ---------------- <br />St , 'ntendent <br />LABOR AND MATERIAL USED <br />$IZ4 <br />lend Connection Complete <br />Saddle mplete <br />2..._. <br />. - �0 <br />Service Crock <br />Service Bux <br />--------------- I ------------ I ------ --"------------------------------------------- ------ <br />No. Hours Labor _. -Cost --- _ �9._•.V_7J____ _/___________ <br />Cuts in _(�l�r«ti �Z �f_�X cR��-______ ------v_—Sq. Ft. <br />4"x1L---------- ------ <br />_. x _ - ---- ------ <br />------------ <br />-x------------ ------ ---- <br />Total, �Sq. Ft. <br />Remarks------------ ------- ---- ---------------------------- <br />------------------------------------------------------------------ ----- <br />Order Received __________�`%_ _ -------------------- <br />Work Completed ---------- - ! '�---------- --------- I <br />Foreman <br />