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W. O. Form 4 ISGO �-I-� / �, p, <br />CITY OF CVERCTT==1Vater Departrr:,;�t <br />•�.pplicatic�n for Water <br />All I:Ianks must be 1' Icd in ur crussed �t <br />F.cerett. __[`�.•'= ��"� ( 1/ <br />__d __�.__-__. ___._. -79f�_!.. <br />"IU 7'HE SI�PfiRINTG\UF':J'P OP 7'HIi 14A'I'FI2 DL'PAR'fMI?N7', <br />C17'Y OP pyERE"I7: <br />f here6y �pply (nr the use of water in nccur.iancr with tl�c rules and re�;ula- <br />tinns n('I'he 1Vater D:partmrn�. fnr purpos.•s and fiztums sta�ed b,•low. <br />UnrinK the time that anr oi tlic water mains rtmp be taFen up by roasnn o( <br />:uq; intprovemrnts authorizi.d I�y [he Cily o( Ia�erell. in ur n( any sirm[ ur allep in <br />�,rinch tl�cy may h�v� �e_n laid. tLe City •a•ill nnt be ret�uired to furnish u�ater duting <br />ihe oru�ress nf such improcrmentti !n any enncumer whnce suPP�l' may Ihus 6e rul <br />��i(, n' be liable (u.^ any �:����.��es fnr its (cilurr so Io do. <br />Applicn[iun No._�G�_��t� <br />.... .____._ _ <br />� I31nck ' �-- <br />"_'__'_"' _I"�L__-� <br />� � Add__'___"___ <br />._._____.__._ <br />7 /l �. - <br />�,.. ---� <br />- '- _. _'_�" """_"'___.Streel <br />_ <br />_' . <br />_ _"'' <br />_ __"_' <br />_""_'____"__"'___ <br />7'Le work to be cxecuted by_'_'.__'___'_' _ ""__- <br />— ---'—� ---._ Plumber <br />Sfate � e of t:ip. . -- <br />� ccc���c <br />`'�//_.Tap bi hr in.�..tcd in Ihr m:i�n. � �'�t✓ � <br />_/ n� <br />i' <br />_ ._'1V��irr�;os<�i <br />----� -_B;ilh <br />— -Urinal <br />. --"-_Plain G�ur��i ii>,!dr <br />� '-__Sidc u�alk wasLcr <br />-- -..__Ilosebi6outside <br />—' _ ...Ifum bib (or building purpuses � � <br />..--��-._-liosc bib inside <br />--'--__.liib(orstaolecontaining______ . �. <br />...__stall__.. �! <br />-__`_.Numbcru(pers,�nsinfamily /��. <br />._C�____NumbcroiraomsinbuildinK l <br />l'he premises are t�� be used as a_'___ <br />.___________.. <br />���u�vnero(thepremisesis _'__ -. -"--.- <br />_'_"_' _ <br />-. _ _ _ ___'__"_"' <br />:�t:en[ is . ___' -""' <br />.. ___.... ..__"_"'_'_ .. <br />;�pplicarnn.:illhough signed, shnll not br bin<iing upnn Ihe Citri nnlil ac <br />' . The Superintendcnt of the 1V�te/r� Ucpnr�mm�,J[. <br />Siqncd _ �/�1f//,�"� rf/��,`/f1Q-�-1�1v <br />"_" <br />. _.. '_' APPIic:� <br />Arc��yled /�y 7 <br />`'� �:��__:i9 � �i,/J� _ -_.. ... "'_' __'_'_ _'��". <br />/ ��� <br />�mc�.c-i <br />