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` W. D� `orm J IIXll 11-10.74 I ' <br />1` �' . , � ' <br />' CITY OF EVLRE'TT---Water Dept. <br />- APPlication No. D �..`�� �Y3 192..._�. „ <br />� F �`._ _. <br />�� stall ._ inch w et setvice pipe <br />For_+�._ 1\ <br />_ <br />.On.. �d�05 �"�(�J�OY ........Street . <br />._. . .... ..... . . <br />Loc... __ . __ Block No .. ..... _ . ...._ . .. �'�`--� <br />_...._ .. ... __.... <br />Add iNon..... _ _ .................... _.... . ...... <br />. .. ..................................... . ...._ ...... ...__... <br />Remarks................ . ............ <br />_ ....... ................... ...._. ....... ......._.... .......... ............ ........... <br />_ ....................__............_........_.........._ _......._.._............__..... ............................. <br />___..._ ................... _ ._. _.__......._.........._....__............... <br />_____ <br />_ ._ ........ <br />_. <br />_.... _ <br />�:. _� K�� <br />_ 5 .... ,� <br />------= - - _ __ --- <br />__ <br />-- ----- --_- =_==__ <br />_ LABOR AND MA1'ERIAL OSGD <br />No I S�ze � -- -- - - - — � - - - - � - --- --- <br />— �_-- -- - -- - -- -- -- -- <br />---- <br />�•�� �� .-I. 3�>` k rz�l Lend Connection Complete <br />....... � ....� .�i`+r r...._ I Snddle Cqmplete <br />......_..4.........St.� _ .. �!h... � ,� <br />F ....._. _...'�-..:S:f......._ ..........................r�oc <br />. <br />...........L...._....._.�.. CS°........... Service Cock . <br />.........�:__,......_.j..�.r"2.4u Scrvice Box <br />.......................... .. <br />�i.... ....__....._._. . ._........ ..____..........._ ...................... ........................................................ <br />No. Hours Libor...........L ..........................Cost._�.=.''.................................. _ <br />_ <br />Cutin........._�.c._.........Pnvement...._ .............X....................__ _..................Sq. Ft. <br />....................X............ ........... �� <br />.................... <br />....................X........................ �� <br />.................... <br />....................X ...................... ,. <br />................_.. <br />Totnl ....................Sq. Ft. <br />.'- - — � -- - — <br />- - �/ _ _ -- <br />Yry � �-_ <br />J ' <br />Remarl,s i1PleCi;11 Si�n \'n._ �.��.. <br />_ � <br />_.. q�i.Z�'r.:.r_a.r'�_ � ...� _ / <br />' _. <br />_.. ._ _.._ _ � _ _. � <br />Ordcr Received .. .... <br />�C/ork Compicted __ �.��,I� �J • ( <br />_�. E <br />� Foremm ,v � <br />