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� <br /> w. o. ron��0 � • �/i y ' <br /> CITY OF EVEREi T--�1at�r Dept. <br /> Applicatioti No..%:.'.::..:.:....... Date................................................19...... <br /> Install.............................. .inch water service pipe <br /> � �_ <br /> �_ <br /> r or � "- <br /> ...._..-..........__..,�.:................--.............................._-_..._..........._............ <br /> On ............'_.:'...::....:.�.._.._✓_:..,._..-...:.::............._.........._- .... Street <br /> Lot................................:�........................... Block No..................................... <br /> Adciition ................................................................................ ...................... <br /> Remarks _....�..:�::.>r.,y��:.�..:..:._...............................--........................... <br /> ......................................................................................................................... <br /> ................................. ....................... �� ......................................................... <br /> ............................................................................... ........................................ <br /> ..................... _.................................--....... �-. .._............._.......--�- <br /> Superintendent <br /> L.1YiOR AS�D 11SATERiAL USED <br /> No. Size I <br /> --�-�--- ---'— — <br /> ......_........................................._..I :.ead Connection Complete <br /> ...................................................... Sa�dlc Completc <br /> '......................f t............................ .._.....................................................................Pipi <br /> ........._...._._.....__...._.._......_..... Scrvicc Cock <br /> ............_............._........................ Service Box <br /> No. 2{ours L�bor..............................................Cost.........................---........................ <br /> Culin................Favement......._...........X..................._... ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> .........__.......X...........__......... �� <br /> ........................ <br /> ...................X........................ �� <br /> .................. ..... <br /> Total .................... Sq.Ft. <br /> -------------....-- <br /> P,c�n a rk�........................................................................................ <br /> _ .... ._.............._............................................................................... <br /> .................................................................................................................. <br /> Orderreceit•ed...........................................................�---................................ <br /> �Vork Camplcted..... ............................................... _..... ........_................. . / <br /> Fareman �/ <br /> �� <br />