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6 �z s- J;�.G ���-- <br /> w. o. roew �/ ` <br /> CITY OF EVEP�.cTT-Water Dept. <br /> Application No,/..��.�:5.✓ Date........../..'..'.3 G...................19...��! <br /> _� <br /> nstall_...:�_::...............inc �water servi e pipe <br /> �� �' � - .� � <br /> For ../C ...ly......., :t,:l..4f..��..t.f..r.x_�...... .cc:x:7?..:._�:c=.�� <br /> / , _ �,j / <br /> On ......._.,1.L._�.......Sf.....r.r..F.....1.-.._Ii✓r':.4Gl�L.:F.:.�:.iJ=�... Street <br /> Lot................�......................................._.. Block No............----...............---��- <br /> Addition ............................ ........................................................................... <br /> Remarks ................�...N.....----...... . . <br /> ..............!J.. .......7.v�..... ��c(f-.....................................................---• <br /> �.�.................................. ........................ <br /> ........1. .. ��........ .. <br /> ................................. � <br /> �.."..'� ; . ... ............••- <br /> ..............................................................._...--...'.. �+- �-4.c. . <br /> ....._.,........... .../..... <br /> . ...� . ....l�.�-.�=. <br /> � <br /> ._................................................................_1.... _� �� <br /> _l�-�............�j.1.:...._��._ <br /> Superintendent <br /> LABOR AND MATERIAL II3ED <br /> _ No. i Size � <br /> ......................................................I :..ead Connection ComPlete <br /> .................................... Saddle Complete <br /> ...:�.:�:�.0............. <br /> ..............J.....It.. � ...............:........................................................Pipe <br /> ......................:..........:::'::.:.........._ Service Cock <br /> ......................._:.....:..::.....::.,:.:...... Service Box <br /> � No. Hours Labor..............................................Co�t.................................................... <br /> Cutin....................Pavement....................X........................ ........................Sq.Ft. <br /> . . .. . . ....................X........................ ........................ <br /> ,� <br /> � ....................X........................ ........................ ,� <br /> ....................X........................ ........................ „ <br /> Total ........................Sq.Ft. <br /> kemarks.....:.:.......::.:...... .......... .:....................................... <br /> .....................:...........:..:....................................................................................... <br /> ......................:.:.........:..�.:..:.....-•---...................................................................... <br /> OrderReceived......................................................::..........:............................ � <br /> \Vork Completed..:.::::..:.:...: : � � ..° ��" '" <br /> .. ............................ .....:..�:::..:.:. <br /> ............... <br /> Foreman <br />