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� <br /> APP� I <br /> No. �I���� CITY i)FEVERFTT ORRERE NO. , . �. �I_ <br /> APPUCATION FOR WATE.R SERVICE �' <br /> �PIXED DATE S��__�� <br /> � /J 1 �Z <br /> � DEPOSIT s G✓">� W. O. <br /> No. <br /> SERVICE (e••AODpE66)_!C�'"4� ��C/V�K�c.`i N'UG dLK._��LOT�3�ADD�NI.�LGC?�ST�(�� <br /> � ._ � ,� <br /> OWNER�� C5.!�__7�i✓ _GONTRACTOR_ <br /> ?� LAT ) —'—'— <br /> INSTALL� ED SERVIGE____ <br /> I HEREBY APPLY FOR THE USE OF WATER IH ACCOFUANCE WITH TF�E <br /> ORDINANCES AND POLICIES OF THE WATER DEPARiMENT NOW E%ISTIN� <br /> OR AS SAME MAY BE HEREAF7Eti CHANGED. s��NEp: _ _ /_��. . _ 1 _ <br /> yc��.���.�. <br /> MATERIALS I Yi IN. 1 IN I 2 I �i I PRICE AMOUNT <br /> L <br /> PIPE � _ . - - COPPER-- GAIV.-• STEEL ' ' I � <br /> — --___-- .. � �1_� <br /> �_ <br /> CORPORATION ` � I � <br /> CURB COCK OT _` I I <br /> SERVICE BOX PLASTIC •- C I l I <br /> METER VALVE � <br /> METER No—_—__—_ _ _. TYPE: I 1� — —__— —.__ --_— <br /> METER BOX CONCRETE _ _FMqLL LARGE I <br /> — . , '__) _ _I.-- — <br /> , .-,� l.l�:��� � .. � 7') _ I—� I__— . <br /> —I �—i__ —. _ <br /> —i — _.T� — <br /> — — — — �—I_ � .- � . <br /> _.—__--—_— _"_--_ � I I _— <br /> �--�_-- __-� I--- � <br /> I � ON <br /> DATE INSTALLED: � OFF SUB TOTAL <br /> COOE � L�OOR AND EOIIIPMENf RENTAL I HOURS HATE <br /> I ____._-_- _-. .. -_ � . . : , <br /> I _-__ ____I <br /> � �4-�� -�j=_ � �-- -- - <br /> � , <br /> ---- - _ <br /> , <br /> , , <br /> --� - -- - --- ------ � � - <br /> , --- - - ---- - <br /> ! TOTAL <br /> REMARKS: \ <br /> —_ '___._- —' . _. ____. _._ ___ ._.— _. _ ._'____ ____ ____ __ _____.._.. <br /> --__—�� <br />