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L y�wRlCp[ OH •SI " � ` .�f <br /> \Y. O. rORM ] � / , � ` } i � <br /> CITY�F EVERhTr--Water Dept. � <br /> Application No...:.././��r Date._:---...._-_-.1.....::....�f...........19..... -` <br /> Install...............................inch watei service pipe <br /> , , '% _ ' . <br /> �OL ....................:......:.......:.:...:..._:......._................1...:...._..:l..:::..::..:..:....:..__.' ; ' <br /> ...:...:........::...._.................._: , <br /> � -, �. . <br /> On ...-----.....�::.:.:..::.::.................... ....... Street <br /> Lot..................�--...............•----•-.•-....._-•---.. Block No........_......_.._---........_... <br /> Adc:ition ................................................. �---.....................---........... <br /> ................ <br /> Remarks ..........1.........---------.............----........................................-------.... <br /> . <br /> .........................:..:..........3..:.......:f..:...::.. ....... .. ..::.:....:............ .............. <br /> , "I[f.�..:...:.....�._.........:.........:......................................................../4....................... <br /> ...............��....;............................................_..........\�............;.i......................_... � <br /> ,/�Y�� �` � .- . ...: : . .:..:._: . . _ <br /> /... ............t1.----.........._......--•--............._\..............p........._ :.-..._. <br /> i. � ...� .�...... I ,-7� �`� 7 � Su erintendent � ` <br /> 6� �, I .. '� t�� `n ._ <br /> 1 <br /> � . LABOR AND MATEftIAL DSED �- <br /> No. "(-- Z I — -- <br /> _,,, ,.-__._„............... .. ......_.... Lcad Connection Complete <br /> �� ............... .................. Sa�dle Com{ilete <br /> ............_..... � <br /> ......................St.::....-. ................... ..................................._...................................Pipe <br /> ..................................................... Scrvice Cock <br /> ........._............._....... Scrvice IIox <br /> No. Hours I.abor..............................................Cost.................................................... <br /> Cutin.................. .Pavemenl....................X......._............... ........................59.Ft. <br /> ....................X........................ �� <br /> ......._............... <br /> ....................X........................ �, <br /> ........................ <br /> ....................A'........................ �� <br /> ........................ <br /> . Tota] ........................Sq.Ft. <br /> — — -..---- -- . - .. — <br /> �� 7�; ) / , <br /> Remarks........_.:1...........:�....:.......:.................:..:..................................�...,..,...... <br /> ' � ,.�."� <br /> .............. .............................................................................................._............. <br /> � <br /> OrderPeceived.....................................................:.......................................... <br /> \V'ork Campleted.::........::.. .�.�.0..:.:....'�.......................... ......................... <br /> Foreman <br />