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! <br />/ 3 S3 ,,-,,,y.� <br />w. o. ron, O � � <br />CITY OF EVF:RE�fT--VGrater Dept. <br />Application No%:. �:.�-�.::: ... ;' Date.......d....: ..� .............................19_L � <br />/ 7ns all ....................`.:..... .inch water service pipe <br />� _.�Y'��"' "� f < <br />i <br />F.,r ..._._..._�.:� .:..::...........�1..:.�....:.' c.<.x.:._c.::r...:............................... <br />-J ;; -� -> '7 <br />On ....s:�.r..-...—`2--z.........l::..� 4 i� �Y..`.S% ................................... Strret <br />�... .. .... .. <br />r.�� '•"='�. I -- ....................... Block No........-----.................._... <br />..............�........................ f ......................................----... <br />.........C..:/..a.:.:c.::; -:)._�-:s.r..�.:� ...................................�--.. <br />LABOP. AND MATERIAL USED <br />Le. d Connection Complete <br />Saddlc Complc:e <br />Servicc Cock <br />Scrvice Box <br />No. tiours L�bor .................... <br />Cut it . ..................Pavement. <br />Superintendent <br />........................Sq. Ft. <br />......._ ............... �� <br />....................X........................ ........................ <br />„ <br />....................X........................ ........................ �� <br />Total ........................Sq. Fl. <br />------ <br />-- Re�narks ............................................................................................................. <br />Order Fteceiced.._.......... <br />\Vork Completed_......... <br />............ . ............... ..... .. <br />.......... .................. <br />Farc n <br />a <br />