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/S Z � � ;.,,� - <br /> w. n..roarn a. <br /> CITY GF EV�REI�'I'--Water Dept. <br /> . ,� _ <br /> Application No.:. .:.:...:. .:. .�.. Date.._..._.........—�i ..�.................19...:;.- : <br /> !• I�stall...............................inch water service pipn <br /> ;� :, . � � . <br /> For ..........................:.........:..:_._........._....................___::...:..................- ... <br /> -� , .........._:.:..:�:�:.... ..:.....':.,::............................... Street <br /> On '..:'.. � . <br /> i. . . <br /> Lot._................_..--.................�..:........... Block No.............- ................._.. <br /> �ddition ..._..............................�_................_ ..........�........ ........................... <br /> I?emarks ..._......................�...�....:' ,.._..:..._...:..�.....:.::....................._....... <br /> _...................._......._......_._..........-............- ................................................... <br /> __..._............................................................................_.................................._- <br /> ............... ............................_.........................................._... .._..._.._....... <br /> .................... ............... ..................................... .......................................... <br /> Superintendent <br /> I.ABOR A*iD MATERIAL IJSED � <br /> _ No. � Size I __ <br /> —1---- <br /> ........................_�......................._..I Lead Connection Complete <br /> ...........................I.._...................._. Saddlc ComP'.elc <br /> ....................._ft.........._..........._.. .. ... _................................_.........................Pipc <br /> .............................................__._. Service Cock <br /> ....__..............................._............ Scrvicc Dox <br /> DIo. Hcm�s L�bor__.._....._..._._.......................Cost...._..___..._..._......._..........__...... <br /> Cu: in.........._.......Yavearcnt....___..........X........................ ..................... ':;�, %'l <br /> ....................X........................ ........................ „ <br /> ....................X........................ ........................ .� <br /> ....................X..._................... �� <br /> ........................ <br /> Total ....._.................Sq.Ft. <br /> _____ _____._______ <br /> Rein arks............................................................................................................. <br /> .......................................................................................................... <br /> Orde� Y.eceived......................................................................._---................_. <br /> lVorkComplcted.._._..._............_. .....__......._..._._ ._....... .._................... .. <br /> Forem;�n <br />