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/�i� � � / . i. <br /> w. o. ronr.IO / / '.-" / % . <br /> � �CITY OF EV�REZ"`I'--Water Dept. <br /> ;_ _, ., ;. - . <br /> Application No.�.......,...�..... Date.................;�.:...�.._..............19_l. .J <br /> � In�tall....................._.. ... 'n�h atEc service Aipe <br /> . - <br /> For .._... ....�.<.�_.�.<_...c.Y....'. .�......_�. .:.=.. <br /> � l. .��. <br /> ..... <br /> .......... <br /> On ........_......:L�..�.:..�'�?..;Z..--..���G.:a...;._.:..:: ..:..----.... Street <br /> Lot...................... . ..................................... Block No..................................... <br /> �ddition ............_...................._� <br /> ,.....................:_.... . <br /> . <br /> ........................... <br /> Remarks ......................._......�:�.�.:.1L.r.,:i..::.> ��,: <br /> ........................................ <br /> ...............................................................................................................�-�-- <br /> _.............................-� ..._ _....................................-.........� -......_......_.__.... � <br /> .................................................................................. ................................. <br /> .......................... .. .................................................................. ............. <br /> Superintendent <br /> LABOR AND AiATIERIAL USF.D <br /> _No__ L_ Size ( <br /> ---- — <br /> �..��-...��_���.����-���.-��....�Lcad Connr.ction Complete <br /> _.......................................__......._i :addle Complete <br /> ......................ft....................... . ..._..........._......_......................._.._.............. ..Pipe <br /> ' . ............� Servicc Cock <br /> ............. .......... ............ <br /> ........................................_..:......... Service Box <br /> No. Fiours L�Uor.............................................Cost.................................................... <br /> Cutin......_....._.....Pavemenl_..................X._..................... ........................Sq.Ft. <br /> ........._._...._X......................_ �� <br /> ...................... . <br /> . ._._.......X........................ �� <br /> ..... ........................ <br /> .._........._.....X........................ .� <br /> ........................ <br /> Tota] .._._.................Sq.Ft. <br /> ---'- --------_--- <br /> ------ <br /> Remarks.......__.............................................................................................__ <br /> ............._..................._................................................._ . <br /> ............................................................................................................. ...... <br /> OrderReceived.._................................................................. -- ................... <br /> \Vnrk Completed....... ...._........_...___................. . _.._............. _......_...__. � <br /> Foreman <br />