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�' 0. Fc�m a i$CO 3�- V C. P. <br />CITY OF CVERETT==�1�ater Department <br />Applicafio� for Water <br />nll bl:mks must bc fillc in or trv�ssed out <br />�/ ���{ <br />Ijrrrctt.. .___.. �0%_=. __'___..19i"V.. <br />'I'�� '1'HE SUPGRIYTF.NUIiK'I' OP "I'lil A i ER U13PARThtiiti"f. <br />cnv or• �avi:ksrr: <br />i n„r�•i>y :��n�v t„r u,�� �„�� „t water in :iccordance a'ith the rulcs :md regul;i <br />ti�o, ��('�ite Nater 0.pnrtin �nt. fur nurpnse, :md Il�tures stn�ed bdmc. <br />Uurinq Ihe tinte ihat anp ui thr water main; ma)' br [akun up b)' re.�san nf <br />nne imoruvements autliurized 6c thr Citp ut Iiverett. in nr u( m:)' strcet or all�•y in <br />�.vhi [h Iher mnY h��vc Ueen inid, the Cily'.vill nol be rcquired to furnich waler duriny <br />�h�� orn�;ress �rf auch improvementv to anY consumer k'hose suPply ma)' ihu= 6u � ul <br />u!L ��r bc 1ia61e (ur an>' danu�us fnr its [ailure so ln do. <br />i ` <br />:1Pplirntint�No.'__'�' ��-_ . <br />Itluck c.l .. ....�Lsot�_.____._...__-.__-AdJ. __...-.-_-_-_-. <br />\u._- _. di •��--. �V�__. Stree[ <br />��_' '_ _ <br />. .._ . .. ... <br />_.'_ . ___""_ .. __'_'.__"_"""___""" <br />'I'he wnrk to be ezetuleJ br. ._.''______ '_ '__'_'_.''-_"--_-_ Plumber <br />titatc � c �d tap. <br />��'.'P:ip to be iuserted in Ihe main. <br />_ ____-��':�«rdusct <br />. _. _ _ -_.. Rath <br />.. . Slrinal <br />-.' . _ _ _Plain (autrt insidc <br />. ..__Sidc ��'al'K «'�sher <br />._. ..._Ilose 6ib uulside <br />. .. . -.Ilose 6ib (m' building Purp�ises <br />_ _... H��sc 6ib insidc <br />__Bi6(orsUiblecuntaining _.__.__--stall__ <br />�� "Numbrr �d Pcrsuns in (amily. <br />� - <br />..c:Z____Numbcr af romus in building <br />'I�hc Prrmizc.v- , m to bc used as a_-_ '_' <br />"'"'____'__"'_"_'_'_" _-" <br />'1'he owner of the prem ises is _ - -"' _ _ _' _' _ . _. . _ .. _' . ' _ -"' -' _ _"""' .. . .. <br />'1'hc:fFenlis ..._ '_'_'_"_""' .. ._"""_.__""'.___.'_._... <br />'I'his applicatinn. althnu�;h signrJ. shall not be binding!ip�m/ the Cily, imtil :�e. <br />, rptrd by "fhe SuperiNendent uf the�lVntcr Ilep:�riment. lL,�-�^�) <br />SiFned _\��4'(}�'_-1�-�.f�/LJ`-<t-- ,:_-"'_'Appliemt <br />. . - . -t;- : - <br />/ -, <br />Atrcn�rd �:-��- .7 �f__"�l�.i 13y7' __z' �' _ _. -., �. .. -.. <br />- ' <br />