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W. o. FORM a //_ t a� 3 d O 3 <br />CITY OF EVERE T T--Wate- Dept. <br />Application NolZ:3A...... Date...........................j...-. 19.(: Y <br />Install...............................inch water service pipe <br />For.................................................................................................................... <br />On ............_/� nP7 9 rN...... ....................... Street <br />Lot............................... ................ v............ Block No ................................ ..... <br />Addition......................................................................._..........:...................... <br />Remarks ...... . <br />......................... <br />:.!...................................................................................._. <br />No. Size <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />No. Hours Labor..............................................Cost................................................... <br />Cutin....................Pavement.................... X ........................ ....... _.............. Sq. Ft. <br />.................... X........ I ..... I........ <br />.................... X........... ............ <br />........................ <br />-------------------- ._............... ......... ........................ <br />Total .......................Sq. Ft. <br />Remarks...................................................................... <br />DrderReceived................................................................................... ........ <br />WorkCompleted........................................................................................ . <br />Foreman <br />