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N'. D. Form t 1500 J-41 ] G. P. � � � <br />CITY OF EVBRETT==Water Department <br />Appli�=atib�n �for Water <br />:\II blac4s must he filled in or crossed uut <br />Iiverelt._.._'______' y� S --Iy3�� <br />.__.'_--./-'_ .._...,.._ '_ <br />'f'U TIIG SUPIiRiNTENDIiN"C OF'fHl? NATHR UEI'ANTDII3NT, <br />CI7'1' OP E`/L(2GTT: <br />1 hereby apply for the use o( n•atrr in :i:cnrdance a�ith the rules and regul:�- <br />tinna uf 7'he 1Va[cr Uepartmanl, for purposes and fix[ures statcd bclow. <br />UurinK the �ime that any nf the �cater mains may be taken up by reason ot <br />anp improvcments authoriud bp the Citp nf Evcrett. in nr o! any sireM nr allc}• in <br />which they maY have been laid. the Citl' ��'ill not bc required lo lurnrsh watcr during <br />the prnqress of such impravements tn any mnsumer whnse supply may ihus be cut <br />nB, or be li:�ble fur :my damages for its fnilur.• sn tn do. <br />Applirnlion Nur.l..__ ���. �%_-� "_' <br />AIncA "��%'b�_'" '_"_LoL^'�g`-��g__',__,'__ Add___'.'______"'__ <br />\o..____. __ �%�.�-�'�+^�_..Stree[ <br />"".._ .._""'_"' ' ""'_""_._' """"'_""""_"'""'_'_"_'__'_"". <br />'fhe�eorktobee�ec�rteclby ____.___�¢—t� � .___ Plumber <br />s�atc srze ��r tap. <br />2• <br />J" __ 1'ap ln 4c ins:rted in the niain. , <br />----J'_--1t'atercl.sct ;� �. �) S-I �-- <br />____�.____13atli /�' <br />..._._ .Ilrinal <br />_"'___Plain fnucel insidc <br />.__"'____Sidc ���aL'< washcr <br />"_"' _' . _ Huse Lib oulsidc <br />__""_ __. Hosc bib for buildinl: Purpnses <br />. _ _ _ _"'.. Hnsc bib inside <br />_ .'__'_.. _Uib fr, stablc containinR__ _ _ ___ _ __ __ _tall. _... _ _.._ <br />-_. _.""'NumLcraf pers�ms in famil�. <br />.. ___."d___Number af rnums in building /� <br />'Phc p�crt ises ;�rc ro be uscd as a_.__ �L4�.(,�yC�. _ <br />._ . . _ ____.. <br />_' _" <br />`� '— " <br />1'heownerotthcPrcinisesis ___�...__ _" ..1�r.�.-c.�!_�C�._'__._.__.� <br />Theagen[is "_'___'_..__..__'_u_ <br />Tliis applitati�m, nithough siqncd, shaP nut bc binJing upmi Pm CiIY� �mtil az� <br />cepteel by Thc �ui��rintcndenl ��f t� 1Vntr � Ueparimm�t. <br />�- -�- �--��,� <br />Si�;ned. _ * . ._ ._ ��.__.___.Applicnnt <br />Acrepced ,.... ]_ �� By/ �� __ <br />''`'�/J ✓ . im� ,� <br />i ' � 4 <br />