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1� <br />V <br />5. j <br />W. JN. 4-A ?F VE'RETIT—Water Dept. <br />ApplicationNo-xa 19.. . <br />.... Date ............. ...... .. . ..... <br />Install ...... ......... .. ......... incll,water service pipe <br />For....................................... <br />On................... ) ....... <br />Lo:.. .............. . ................. — <br />. ....................................... Street <br />I <br />Block Nr ........... b�q .. . ........... <br />Addition.. ... .......... 7 .............. .................................. ....... r ......................... <br />Remarks .. <br />..... ................ t <br />......... <br />....... .................. w .......................... <br />................................ <br />V <br />LABOR AND MATERIAL USED <br />No. I Size <br />Lead Connection Complete <br />Saddle CorrPle <br />a <br />.... .. .. & .... ............. Pipe <br />Service <br />Service Box <br />No. Hours Labor..........................................A;oSL ............................... * .............. .. - <br />Cutin....................Pavement.................... X ........................ ........................Sq. Ft. <br />.................... X ........ ............... ..... .................. <br />.................... X ........................ ........................ <br />.................... X ........... ............ <br />Total ........................ Sq. Ft. <br />Remarks................................................................................. <br />........................ .............. <br />Order• Received ........................................... . ....... <br />�, . . . . .1t <br />Work Completedl . .... ... J.1.7 ..... 4 - Foreman <br />