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APPL. ' �'L�` CI'�Y OF�EVL"RETT sERvice . � . . I <br /> No. � �� � ORDER NQ � - <br /> APPLICATION FOR WATER SERVICE � � , <br /> � FIXED DATE��—��-19.!_L <br /> [ <br /> DEPOSIT � 'N. O. <br /> ❑ S �OO NO._-- <br /> SERVIGE tav�oon[e3>�/7•C/�L�-�^'������sLK._��LOT—.--AqIJ� /-y r , <br /> OWNER_� �/ti�-'�--'t�� CONTRACTO��--f_��� <br /> INSTALL_�//METERED SERVICE _--_--.— ---- — - <br /> I HEREBY APPLY FOH THE USE OF WATER IN ALCORDANCE WI7H THE � <br /> OHDINANCES AND POLICIES OF THE WA?ER OEPARTMENT NOW EXISTING C��� <br /> OR AS SAME MAY BE HEREAFTER CHANGE�. eicHeo: X . ._---""'"—S� - ww._---- <br /> MATERIALS � IN. IIN. � 21N. I � I PRIGE AMOUNT <br /> PIPE CCOPPElj/--�GALV.--STEEL 0���___�_I _ <br /> CORPORATION � I I _ <br /> CURB COCK OT � I <br /> SERVICE BOX PLASTI -- C I � I I <br /> _ — i — <br /> ME7ER VAWE � <br /> METER No. 7YPE: I !S _ <br /> METER BOX CONCRETE SMALL LARGE <br /> I �I <br /> — _—�_ _ — _ _ <br /> _— I —_ — <br /> __ --__I — — <br /> _I I —.— <br /> ON <br /> DATE INSTALLE�: �I_� ` 7 � � OFF SUB TOTAL _ <br /> / / <br /> COOE I LABOR ANO E0�11PMEN f PENTAL _ I HOURS RATE <br /> I --- — --- —�' o f��--� 5r , <br /> I -- �����l�I b _ <br /> —� -- - / _�y 2 1 I �g-- <br /> i �.3 ff f rr3 c�:` � 8 -- <br /> — - - � --- --�� �.�� <br /> IJ_ <br /> — -- � <br /> —� - - - - - -- ---- � -- <br /> � TOTAL <br /> REMARKS: .J OG -- /-� 7�' ere. 'J�<�j��lhC�/P��� � c�C'O . � y R �� �. <br /> �_C- l.t�—S, �� `L�- <br /> 4 �r'-f�,�ryd— !!�e ��a�/d i�o7`-Fnd s'criar 11��//� y'1't�•���tcf�.. — iL//Gc.� <br />