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AF'PL. � � ( � � � A2PLICA7'ION FOR SERVICE <br />No. � �ITY AF EVERC•TT WATER DEPT. <br />,1 f�"-. <br />� FIXED <br />� DEPOSIT S /L' C'_ � � � /S T � /yZ•'�I 3 '4 � � <br />� /, � <br />SERVICE fEW Ao�q[ss) � /;" �/,'. �fu�� `" LLLG /J`� !•//LK._—LO'I <br />� <br />OWNER.��� '�'�` '. `� - �` ����� �CONTRACTOR <br />L . /�FLAT �.•;/.'' e.r�.��. <br />INSTAL J � METERED SERVICE— ---- <br />I HEREBY APPLY FOfl THE USE OF WATER IN ACf_ORDANCE WITH THE C �_ <br />ORDINANCES AND POLILIES OF THE WFTER DCPARTMENT KOW E%ISTING .. <br />OR AS SAME MAY BE HENEAFTER CHANGEO. s�GNEo: X-�-�y -�— <br />MATEFIAL9 �/+ IN. 1 IN. � 2 IN. �� <br />PIPE _� COPPER -- GALV. -- STEEL __ I �� I <br />CORPORATION I � <br />CURB CO^.K 07 ( <br />SERVIC�" BOX � PLASTIC� ` C I � I —� <br />�____—'_ _— <br />METER VALVE <br />METER ND. TYPE: __ I Sb __ _ _� _ <br />METER BOX CONCRETE SMALL LAftGE i <br />- -,- ! � I <br />r.s.�-��--, r�r�', _ <br />J� _ . .. , . �.. _ , ' �� <br />DATE INSTALLEC: <br />t " <br />COUE I <br />u ON <br />❑! OFF <br />�LADOR AN� EOUIPldENT RLNIAL <br />SERVICE N� 5 3 5 <br />ORDER� �7 <br />. / �� i <br />GATE • '�." . _19.�__ <br />; <br />W. O. '_ <br />r� I ' . <br />r <br />�_�L=-� C -r <br />��f�RICE AMOUNT <br />i ���� �l ���i: <br />�. <br />� <br />SUB TOTAL `)/ �� <br />HOUP.S RATE <br />f. ,. .�. li i." <br />�I I <br />�r' �� ° . _' i 1 ��� � rl :�. <br />� •J <br />TOTAL <br />P.EMARICS: � <br />�_ __—'_ _ ._—_" — ._ _ —'__ _- <br />— — _'—_ — <br />_ �il� " <br />1 r , - _ _ __ _ ,__- <br />