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O�D F�m����'� 0 6 VERETT--Water Dept. <br />�.i <br />Application No ..............._........ Date......._....................._...............19...--- <br />Install ..........:....................incli water sen�ice pipe <br />or ..............._._......... - ................... <br />... . . ......._..........- - ...................- -�--- <br />. ........................ <br />On ..........................:..... ..........- <br />Lot........................... ................................. Block <br />Addition.............................................................. <br />Remarks..........:..:.:..:.............--.• _................. .... <br />_ • <br />-" - i•>�}.:rr.-1 .r-,., _ .. <br />............................................................:.:'................. <br />.................................................................................. <br />,. , <br />.......... _ ... . ..................7,.. _:.... _..... i _...:............ _...... _. <br />..... � ............... � .............. <br />r . ............................... <br />............ <br />�. / — <br />LAIIOR AND MATERTAL USED <br />No. Siu— -- _ _ _ . — -- <br />----- <br />..._ ....................._......_...._1 Lcad Connection Complete <br />.................................._..._.....I� Saddle Complete <br />.............ft......................___' ......_........._......._........................ <br />.......__..._....._ ..................... Service Cock <br />Strect <br />Superinlendent <br />................... Scrt•�cc IIox . : _ <br />No. liours LaUoc_......_............_...._.._......_...Cost ................................................... <br />Cutin._._.........__Pacem�nt_._.__ ......_X ........................ .................._.._S9.Fl. <br />, � <br />� .......__.._.....% ........................ ........................ <br />� �, `'i' <br />�.�� , . ........._,....---.X.__..._ .............. ........................ .� <br />....................X........................ ........................ <br />„ <br />Total ........................Sq. Fl. <br />-- -- ----- -- <br />— — Nnmarkc _ . .------'-'-'--'.........._-"---...._......_-- .........................'---................ <br />__..._..._......... _. ._ ............................................._.._'__- <br />............_._.__._...__ _ ..........................................................................._............. <br />OrderPeccived ___ ............................ .........:._.......................___.,�.....--.. <br />14m•k Completed._... �/...��/['..�:.,_..:�.�.:.:::.� .::........... '...... <br />Foreman <br />,� <br />