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4 <br /> �_.� ,,. , - _ - < ,� � ,.,-,--� 6 -�9-z3�� <br /> � <br /> ' - r ' <br /> W. D. Form � I500 d-1-1 7 C;P. <br /> CITY OF EVERE'CT�=Water Department <br /> Application for Water <br /> All blanks must bc hlled in or crossed out q <br /> N <br /> Everctt. ---� -�y��.�-�-='---.1�_'_ <br /> TO THB SUPBRINTdNDRNT OF I .WATER UEPARTMIiNT, <br /> CI ' ' ON E`/ISRETT: <br /> 1 hereby apply fnr thc usc of waler in acrnrdance with the rules and regnla- <br /> tions o! The Waler Deparlment, fnr purposes and fixtures sta�cd Lelow. <br /> During the time that:my nf the W'ate:mains may be taken up by reaeon o( <br /> any improvemcros authorizcd by thr Cin�o!Evcmt6 in or o( any sireet ur alley in <br /> which thev ma)� havc becn laid, thc City will not be required to furnish water during <br /> the proQre::;nf such improvemrnls to any rnnsumer w�hose supply may thus be cut <br /> a(f,nr bc liable tnr any JamnKes fe s f:�ilure so to dn. <br /> ApPlicntinn No."�'�� ---- <br /> .i i <br /> lilock _�j..�o3_�-'_____I.ot__� � '' Add...___ _____.____' <br /> Nn.__fY_-'_��_�".-_ "' ' Street <br /> __""'. "_______.. <br /> .__'_____________'_� ' _'____".--.._______-_______________.___.____'. <br /> 'fhe work to he execu[ed by_._____..__.__ .-..._--._._._-------- Plumber <br /> Statc/size��f tap /'�' � ', � <br /> _ _�J_��Y.Tap to be inscrted in lhe main. � �J 1( �— , \ .. .. <br /> �f (D <br /> ---_'�---1Vatcr cloect ,:. <br /> .____�__.Bath <br /> __.. ._' .Nrirt�t'-- ' <br /> . __�___Plain (aucet inside <br /> --�i�leavxik�wa5lYr � � <br /> ..._'L_.'Hose bib nutside 'ra il ,Af. <br /> f <br /> '__""_'.1 mg pur �_ � . . . <br /> r <br /> .'____"'_fime-btlr1v51[�e'� �. <br /> . (. <br /> !iib fur t hl�r�.,�=i�' �"� ' <br /> _.'_""' —..-----......___ _.___ <br /> ____.-.___Number ot Pcrsans in (amily <br /> ___� __Number n(ronms in buildinq <br /> The premises arc to be used ns a____. _----'---" ���������-�-- ---"� <br /> ��L(.�O"T�W'V v._� <br /> 'Phe ownerof UicPremi�e5is __'_'____________ _____._____.____.___�__'_ <br /> Thcaqentis .___'___'..._.____'________' '_.__.____.___'_-.___________ <br /> This applicntion, although siKned, shall not be bindinq upun the City. until ac <br /> pted 65'Thc Superinlende t o lhe//�i��lcr Deparuncnt / <br /> ' SiHned- - -- L1'O�%'�-"�__-.- . _ -- -- . -`-'. ppiicant <br /> � � <br /> __ 1 <br /> Accepicd.-�__.:_'.____"_ 191 Ry_______.___'__ _ '____`_____ _"_ <br /> 1 � su nrlmena <br /> 1 <br /> i <br />