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• �-ca-�e F_-ni � v_ <br />W.D.Form! ISUO3-I-17C.P. - /� � �U��.�� <br />CITV OF EVERIE7'T==Water Department <br />Application for Water <br />AII blanks must 6c fillcJ in or crossed out <br />lvcrett._ "'_"_ "_'__"/`/��'__'_191�_'__ <br />TO TI1E SUP[?RINTENDIi\7' OP TIIF N'ATGR DEPARTMGN7', <br />l'17'1' OP 7:`h?RL•'7'Y: <br />I hereby appl>' for the use nf �cater in nccordance ���ith the rules and rrgula� <br />tinns o( Th� 1Vatir Ueparun �n[, tor purpnscs �md itztures xta[ed bclow. <br />Uurin�: the lime that :m)' ui Ih�� ��'ater m��ins may 6e taken up bY rcason o( <br />any improvemenls autLnrizeJ by the Cily u( lieerett, in or of any siree�� nr aIIcY in <br />�ehich [hey ma5' have 6een laid. thc Cit>' x�iil nnt be rcyuired in lurnish n•aler durine <br />the progress nf such improvaments lu any conswni.r �rhnse supp�)' map ihus he � ut <br />oif, ��r be liable ior anY damage> (or its O�ilure so tu do. <br />dpplirntion No.'__� _�-.�r-.�-----' <br />lilock.'_"'_ "_"L�,t__""_"_'_'___Add__'_'_..______ <br />_' ' _ <br />_\u.__'_�_�'��j__._ '2.G?-*s=__ _ . Street <br />'____'.. <br />'_�.4_ _______ ______'._____________.'."""__. <br />..____.._.' _____. . <br />'1'he�cark lobeesecuteJ b)'.__.'_____'___ _. ..__ .'_____________ Plumber <br />State sizc of tap. <br />�__'i ap t�� bc inserled in tlie main. <br />Z_�__ <br />- --�v,«<a„��� <br />-- - -- ,�,��, <br />-- -- .u���,:�i <br />___._ ___.Plain fnucet insidc <br />_ _ _ _ _"_Side walk �rasher <br />'___"_'._Ilose bib oulside <br />�� _ <br />�,��� <br />w.�o.�n°� <br />""" .___ l lasc bib tor building purpuscs <br />_'___'. "Hosc Uib insidc <br />_ _"" _"' 13ib tur sL•�blc cnntaininR. - _ _ _ _ _ _ .. -. st:Jl _ . . _ ... - _' <br />_ __ .. _"'Numbcr o( persuns in lnmily <br />____"_'_Numbcr u( ruum� in 6uilding <br />'ihe premises are to be used as i____ __'___"'.-.__..__._____ ____ '_'__ <br />"1'he ux�ner ot the premises is _'_'.-_.__'____ ___ ___ ________ _______"____ <br />Thcagentis---'----'�---�-----'-----"--'--�---�----_"-'..---- <br />7'his applicatian, althuu�;h signed, shail �ml bc binding upnn [hc CitY, until ac <br />cepted by 1'h� Superimendcnt ��( thc N'nter Deparunent. <br />Sipned._lhJ-.-`---:_t--�-'---�- Applicant <br />/ �-°-�-fi� <br />Accentcd-//--- `r�----19� tiy���,,C��------- <br />� <br />� V �--s�r.,im��:��'� — <br />