Laserfiche WebLink
� <br /> � 1.Pr'ebe�M, ".. �' / . <br /> \V.D.FormD �� ��� / � ._� ..C;,f'• /,1.�7 t? ;9( • � <br /> VERETI'--Water Dept. <br /> G ,-- (�; <br />� APPlication No...1'...:/...::...:�.. Date...............:....:.�..........:...i.......19_`'. �' <br /> i � � <br />� [nstall..........��.................inch water service pipe <br /> I <br /> ro� <br /> � ./ /J .................._.......................--��---............. <br /> .... ............. <br /> . . .. <br /> � , , <br /> Gn ....................�......�_.......�..' ,^ .-r � i -� <br /> . . ........................ ._.........---------.. Street <br />' , Lot.........................................................i.'�. Block No........_.....................----- <br /> - - Addition .................................._............._........ . <br /> ............................................. <br /> Remarks :"�% <br /> ................ ............................................................... <br /> _ ......................... <br /> � . - <br /> � � ........._..._.......... .......�..._i_.::1::..i..:!...�.a:..:e...:.. •__.... _................--�---.. <br /> ..-_"- <br /> � � ......�.....:.................................................................................. <br /> I �' ' ' �. " '..........................." <br /> ' r .�....::�/...'....5.:..� <br /> � .....7..._........t. �_!................�................ � <br /> .........."'.... .....""""........... <br /> "` .2 . f � ) <br /> ._!.. ...... ^... .. .. .._...... ......................... � / <br /> ). . , ....:.!. � ;__� <br /> ................""" <br /> ' �'� � , uperintendent <br /> _ " � , r �/ <br /> LdBOR AND MATERIAL USED <br /> __ No. � Size <br /> .................... �.............._....._ _.li Lcad Connertion Completc <br /> ........ i',�Sd I C n lete ' <br /> ��...�..y....tt....:�.........._......� �t�F. � <br /> �................ P <br /> ...................... . I �: U��Cf......�(Lf....Pipc <br /> ........ .. <br /> .................................................. Service Cock...�?1...... U <br /> ...................................................... 5ervice Box <br /> .......................... <br /> ......._... _...........I...... ................... <br /> No. Hours Labur..............................................Cost.................................. <br /> .................. <br /> Cutin..................Pavement....................X........................ ........................Sq.Ft. <br /> ............... . �� <br />. . ..... ........................ ........................ <br /> �. ...................Y �, <br /> ........................ ........ <br /> ................ <br /> ....................X..............: <br /> ....................... <br /> Total ........................Sq.Ft. <br /> Ren�arks...................... ...... ......................................... <br /> ................................ <br />, __ ..........._.............................................._................... <br /> .......................... � <br />� ............................................. <br /> .................................................................... <br /> Order Peceivcd.......- ..............................__............... .. <br /> l' , -- �r% r3;� ;j�.�.��............... <br /> I Prorl: Cmup]eted.._:._.../-...............................:..... .� <br /> ............ ...... .............. <br /> Foreman <br /> i' <br />` <br />