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� <br />" J. Priebe 99255 � — ✓ <br />w. u.r���.��1 l 1 �� � <br />VERETT--`�Iater Dept. <br />��.�� � . . <br />Application No ............. �ate....��.-............. ... .........19.y/ <br />-.— •� � � <br />�.!..... <br />Install _:��-,'„ ..,,.,. inch water service pipe <br />For............................................. .........�- �-. ............................................. <br />� � ....._,. <br />. . . <br />On ................._-r.��.....�..��.---��'...�.�..'.:'_✓...�.::...'.....:__..... Street <br />�7 ' � <br />r �t ..............1..7.:...� .......................... sioo�: rro............<_.:��...........-- <br />: ddition ..__ ...............�.-.--- . . _ <br />. ..... ............ . <br />. . . . ... <br />'_ie7iar4s ,• _ _ , . . <br />..... ....... .... . . .. ... <br />. , . ..s <br />..........................w..:.:.l.bC..:........:...... ... <br />. � ........................................ <br />� <br />rv a. <br />' ....._V�.`...�.�_:..� � <br />` .......................""....................... <br />� ..... .......................................... <br />%,� Superintendent <br />I,ABOP. AND 11iATERIAL USED <br />-- ---- <br />........J Lcad Cont,ection Complete <br />... ' Sadnle Complete <br />� � <br />...... ...�... �.:..._�- ...:......................._.... <br />...._...I Se:vice Cack <br />.�'.ervice Box <br />................. ........ <br />.......................... <br />No. fIour= Lr,bor ..............................................Cosl.................................................... <br />Cutin.._...__......._Faventcnt ....................X........................ ........................Sq.Ft. <br />....................Y..._.----. �� <br />....................n.............. ,� <br />.......... ........................ <br />Tatal ........................Sq. Ft. <br />----------- - - --.—_ <br />� <br />Rc m a r I:s _ ............................................................... . <br />......................................... <br />....... .. ... ....... ...................... ........ .. . . ... . .. ..... <br />. . .. ... .... ..... .......... <br />Order Received ......... ......... <br />... . . .. ..... ....`�...... . . .. .... . . .. <br />j:'or}: Cnmpleted.7-..' � ...y� ... .�. �Clsa+.a-' <br />Foreman <br />