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/�8 ..`�►3` - i;,E;, <br /> W. D. fOHM l <br /> CI�'i Y OF EV1cRETT--�Xlater Dept. <br /> :,�, - <br /> Application No,t.;�.::../J.... Dat ............e:��..'::r::::...'._..............191.::' <br /> Install......._...t..�P,�..........inch wa:�•r seivice pipe <br /> � <br /> For ...............C�n,c.� ..../.5%......._r?.2:<..�.._............._........................... <br /> On .......1.,=.1L........,..%-�..�[�a�......._�.................................... Street <br /> i,ot......-...................._`✓............�---......... Block No........_........_................. <br /> � <br /> - <br /> A!j(j1�.10❑ -��_�-..�..:1�.: .'. ..�r__ <br /> ......i S1.-..........t .. <br /> i <br /> .............. ................y:..........._..................... <br /> � . , <br /> � ,. � . . . . -.r .:.... ' <br /> I'em,:rk_ ......:. .::��y._�.:-........:.:..:..... . . �:.:.G.............---._...... <br /> � - <br /> .............................................................................. ........................................�-- <br /> �..........----.._............_..._._..............iT ;�}�.�......._......---....._................_... <br /> r.:.:............. ... ............................................. <br /> ....... ............_........._................._( � ��,���� SuPerintendcr.t <br /> LaBOR AND 6iATERIAL U$ED <br /> No_ � Size ' __ <br /> .... ................................._.._..._I Lcad Connection Complete <br /> ..................................................._.� Saddlc Completz <br /> ....� ...c_�(:..rt_c..(._i..................................._........Pipc <br /> ........._.�..........f t.. 7.�.{.�............ . <br /> ._..................�......_.^..:�.::;............ Scr�iCe Cock <br /> .....................�......_..._.._......,......... Service Box <br /> No. i-Iours Labor..............................................Cost.................................................... <br /> Cirtin......._...........Pavement....................X........................ ........................S9.Ft. <br /> ....................X........................ �� <br /> .. ........................ <br /> . . ........_..........X......................_ �� <br /> . . ........................ <br /> ....................X........................ .................. .... <br /> �� <br /> Total ........................Sq.Ft. <br /> __.— —r—='_'— <br /> ____--_' <br /> ___ <br /> � . . ..._ <br /> P.emark;...............�.,...: t'...._�.......:....:...................................... -....._......... <br /> _............._.�.....:.ft:.:..i...:.:�':::(.:.:,:........; ...:......_..._..........._............... <br /> .. .......... '7 <br /> .....................5:::.....:l:.l..1.!...�.................................................................. <br /> OrderReceived.................................... --.............�..�..,.........................._.. � <br /> l' .. ' ,i : . , <br /> \Vork Complcted.�..._:..!..:. �....'_._........._...:...:_ :._�..:..:...:. .................. <br /> r oreman <br />