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� ,�- r �t � � <br />w. o..-onu o — ' ' /�l /I ��. �� <br />(=;iT Y (�F E\jERE'Y.`'--VG'ar.�r Dept. <br />� �_/ . � /yil"� <br />Application �:o.c......`_........... Datc........i,�:�;._i.._..iD.c2....._...........19...... <br />In��s.ft• 11 .........,.�.................... .il�ch water service pipe <br />For .�...... ... �� L.r2.�-�z :.! . c-'� ... .............................. <br />�....... . <br />� ^.. <br />, _ � ;� <br />-� � �.r- --3' "<<^,'a�C./� �.........._...._.... Street <br />On ...��::': ��..-z_=-._...1..._�1.:,........_...._,_.�.. <br />I.ot .................................................. � ....... Block No..- ............................ <br />Addition !:. J� � � ,: ..- � ... � _.. <br />Rem:u•ks ......_ ............................................ ..........._......_.............................. <br />_........_.. <br />_._.._ _... <br />_ ..............................................._.................. - �- ......._..........-- <br />__....- ....................___......................_..........................._..... <br />_ ......................... ........_.... -- -- — - --- - - <br />Superinlendent <br />LAROR A\D NATL•'RIAL USED <br />Size I <br />r-- -- <br />..................! Isad Conncction Cor.:Plete <br />_............__� Saddle Complele <br />................. ........ _........ _................ ........ .........._......_....Pipc <br />._.........._.. Servicc Cock <br />..........._ .... Scrvice BoX <br />.._ ................_....__.............. <br />No. Hours Lsboc..........._........._...._..........__.Cost ............................................_.. <br />Cutin ...................P. vement....._._..........X....._........._.._... ...___..............Sq. Ft. <br />......._._......_X ......................_ „ <br />........................ <br />....................X.............._........ �� <br />........................ <br />....................X...................... �� <br />Total ._. _ .............Sq. Ft. <br />____'_—.__'—_ <br />Re�narks .............._............ ......................__................._......_.............._......._. <br />_.._.......... __._..._._.. <br />...._ ................ ..._ _.. <br />Order Received............ <br />\Vork Completed_....... <br />Fore�ian <br />✓ <br />