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r� <br />' --� v-9-�-7-1 i �ti�.-�� �- �'.- -: - �_ <br />W. U. I'orm 4 ' :� V <br />- I(Ou—:i.P.Co.-4-2f.yd . • � <br />City of E��e.rct�.--Watei• Depzrtment <br />APPLICATION FOR �,TA��R <br />Ail L1nul;s must bc fiileci i,� or crusacd cut <br />Lverett�........... � <br />�� - � y . _ .�..�....1.92�' <br />1'0 TfIE SUP�I:1N7'LVDF�17' Ol�' TIl i, 1T' t"�� .•�R DEPAP.TBtErT: <br />C(TY OR I:NL•'LL•'TT: <br />I hc.eLy nnp!p for the use ot �c;iler in ;�,�,ordance �rith thc rules nnd regu- <br />4�tions of [he {9nter Department, for pur�ioscs :md fix�vres ^'. ted bdo�c, <br />Purinfi thc time that nny of Nm �t•ster ntnirs ma�� 6e t,�l;en up Ug renson <br />of nny improcements nuthorized Up tlu Citp of F,errett. in ar of �m•; .trcel or <br />a11e3' in wLich Ihey m�y Lacc Uecn lnid, tlic City ��•ill r,i�t be reqnirc�3 to furnish <br />�vater du�ing the prugress oL such imvrovemm�ts to e��y cunsumer �cliase supply <br />nc�y thus be out o[f, m• be liable for .�o}� damnges irr its fnilure so to do. <br />APP��cntion No......� / (��27�� <br />�y \ yy. ........ `.. j . <br />Lluck ...............-1._L1..�-. � <br />�7 ... .. Loc ..................1 _ . Add..Lrti-�..���'L'e-%� <br />No...._�.�4? /. . . <br />.......... _. ......�[-c.-cs.-_._Street ' <br />. .... __... . <br />... ......__..........__:... <br />...._ .................. _. G... <br />. .. . ........ ............ . <br />The work to be executed by.._...._.} � <br />� I �/ �i ..._.... . ......PlumLer <br />. �..LC-?�-G <br />Statc sizc of tnp, /'� J�. U' <br />� /e' ' <br />������:. Tup to 6e inserted in tUe main, ���3776 <br />.... <br />.......�.......�Z'alcr docet ' '� � � <br />.......�......L`n:li • - � ; <br />� i C... <br />......._—..Urinnl .. . � � <br />�---Z.....Plnin fnucet inside ' <br />......�...._.Side wnik wnahcr ...... ...... ` <br />- .............Ilose bib outside <br />....-`......EOSC Uib for Uuilding purPoses <br />����_�:...Iiose UiL insidc <br />�-�-�--..Bib for stnLle contnining ....................stall......., <br />. ........... <br />.....L...."-..--.Number ot perrona in fnmily <br />�-��(0......NumUer of rooms in Uuilding <br />The premiecs nre to bc used ns n..... <br />.._ _. Gt?.._. <br />Thc o�cner of the ��-�������-�-����� <br />................. <br />Premises is�... . • ��-� - <br />.. . _......_. .�z'ute_.�*e._.. <br />The age��t is .................................................... .. <br />. . .... ........ . , <br />This npplicntion, although signed, sUnll not be binding upon U�e City, until <br />�ccepled by the Superintendent o[ the R'aTer Depnrhnent. <br />Signed....5... �!.`„c� byyl-�t.+?'•.-. <br />y � - - Applicant <br />:cepted.....�� f......�1�...�...-......19?f.� B <br />/ � .... y . . . <br />.. . ....... <br />_ ..... ........... <br />.......................... <br />� � - Superintendc� <br />