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_13 H. [1• IORh us / � <br />CITY OF EVEREITL Water Dept. <br />- r <br />Application No.. �J.. ........ Date ... .,.Z.__._..e _y-sl ta) -r <br />r <br />i raLL....... :+�....... f�.inch water service pipe <br />For............ ... _. ..._... 1....r lt� l:CJ....... ..................._.. <br />On ............_.._. '�_.. rtl.:�l--. .. Sheet <br />Lot..........._..... __...._.._............. Block No ......... <br />Add?ion.............I.)..��........... _.................................... .......... ------------------------ <br />Remarks .......... `J�' <br />n <br />..._.............. ...................... ..._...._...._....__...-................................. <br />.�: :'•.: r.".f_Ml.r� <br />Superintendent <br />LABOR AND MATERIAL USED <br />No. Size <br />_._........ _...... .... ................. .I Lead Connection Complete <br />................ . ................... Saddle Complete <br />..__...._....__.1k�_-......_._.._....I ..........._.. _.................. <br />... <br />......... <br />_................. <br />.. Pipe <br />.._.._...,.._.._..........._.__..__._.._. Service Cock <br />_......_..�.,.._.._. Service Box <br />r.:. Hours Labor ........................ ...... _......... cost ...... _.___....._.._................... <br />Cutin .................... Pavement ................ X.._.._.._.._...... __..._.._.._.._...Sq. Ft. <br />.__.._.._.._... .. <br />........... _... _..X.............. ._... .. <br />.X....................... .. <br />Total ........................Sq. Ft. <br />Remarkn, <br />. _ ................. _..._..................................� .. <br />................................. 1 <br />........... <br />OrderReceived ............... ... ......_�......,.{................._�......----...................... <br />Work Coml,•leted... <br />.'......'.1.: 1................... . ............. _................. <br />Foreman <br />