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S J. Priebe AM V <br />W. D. Form J <br />EVERETT--Water Dept. <br />pp') <br />Applicat„n No...!1......... = ..... Date..................................19.::.. <br />Install.....;.`..................inch water service pipe <br />For.....:i....._ t`.i:L:....... .......:..:....... ::......................... _............... <br />On ...x 3.!>! a ...............:..'.:...:..:....:_.::......_.... - ............ Street <br />Lot...........................................----............. Block No ........ _......... .............. _ <br />Addition................................... _....................... ...................... _..................... <br />r.a_,...r::_:..::.........-............................._............pi...... ..... _ <br />.......................................................................... <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />.......-L/..................................Pipe <br />Service Cdck� <br />Se vice Box <br />a�/ .1 .(..:'......1...�•:.1�x, <br />...:��..:........_......_.._...._. <br />........................................................................................ -......... -.................................. <br />. <br />No. Hours Lsbor........................................_/.Cost..... �-IJ......._.._.._.._............... <br />Cutin .................... Pavement .................... ............ .._....... .....................Sq. Ft. <br />.................... X........... _._.._... ................. _- <br />��.................... ........... I ...... _... <br />C <br />77 i L1 <br />f Total .......................Sq. Ft. <br />L . . <br />.................................... .._........................................................._.... ... <br />............... ........ <br />Order Received........._�.. .......Vork CompletedJ'W...........Q........... <br />. <br />I <br />Foreman <br />