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. _ / '�"3 /�- - � , ���,s� �, <br /> �M D. fQqR � <br /> CITY OF EV�RE'fT-.�(Iater Dept. <br /> Application No.�.:�.:.'�.:..5,. Date.........._��......�. <br /> .......................19.1.� <br /> �/. .'� l ./..•.-.......inch water service pipe <br /> 'X.......<_f�� `�l t.... <br /> �sta L J.........._. <br /> For ...._... ........... <br /> :. � z �1........... <br /> ���.. ............................. <br /> ` J�,-< _ ._....... <br /> On .........1...:._'' ............ : ._ <br /> ... .. ...................... Street <br /> . .................. <br /> Lat.............................................................. Block No.................................... <br /> �ddition ............................ <br /> ........................... ................................................ <br /> Remarks ...... ......................... <br /> �....................... <br /> ( • ,.ly-.:........................................... <br /> ....._.......................................(���..,.:�,z..:.�.r..-.:::......................................-- <br /> ............................................................................................. <br /> ....................... .................................................................... <br /> ......................................................................................... <br /> Superintendent <br /> LABOR AND MATERIAL USED <br /> _ No. i Size <br /> - ------I_ <br /> ...................... ......................-I Lcad Connection Complete <br /> .............................. Saddlc Comp:etc <br /> .......................f t............... <br /> ......... ... ...............................Pipe <br /> ........................................ <br /> ...................................................... Servicc Cock <br /> ................................................ Scr�ice Box <br /> .......................................................... <br /> No. I'.ours I.�bor..............................................Cost......................... ... <br /> Cut in....................Pavement...................X........................ .......................... <br /> ........................Sq.Ft. <br /> ....................X........................ �� <br /> ........................ <br /> ....................X........................ �, <br /> ........................ <br /> ....................X........................ �, <br /> — ------ --- Tatal ......Sq.Ft. <br /> .................. <br /> em arks............................................................ <br /> --- <br /> ................................................ <br /> .............................................................................................. <br /> .......................................................................... <br /> ............................ <br /> OrderReceived.............................................................................. <br /> .......... ..... <br /> \Vork Campleted..................................................... .......................... <br /> Foreman <br />