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% - "' i% � <br />w. o. r�r+ �� o O .. - <br />- - CITY OF EV�RE 1 T--Water Dept. <br />Applicatiou ATo..�::> .�<:r. Date....._.�...:..� ..........................19.�_:'� <br />,: � <br />, <br />Install..._ ..,......... . i� fh water sercice pipe <br />, � ,_. � ,J . <br />For ..... ::[�.�::.;:..4::G:..........:..,.../..C.l..c:�r. :.:.4.i :...................................... <br />� . � <br />On ............::-i...:�..l.:..............%�.�_cS:� T.. �.�� :_.z.c �........_............... Street <br />Lot............................................................ BTock No..................................... <br />Adclitiun.......................................................................................................... <br />Remarks ........................ - � - -- --- -- - � - _ <br />No. <br />......................... ................................................................................ <br />Superintendeot <br />LABOR AND MATERIAL USED <br />..........I :.ead Connection Complele <br />........y Saddle Complete <br />.............I Scrvice Cock <br />Scr�ice Box <br />� <br />No. Aaurs L�bor_ .................................._........Cost..........................._...................... <br />Cut in ....................Pavement...................X........................ <br />.. .....................Sq. Ft. <br />....................X....................... �� <br />........................ <br />....................X........................ �� <br />........................ <br />....................X........................ ... .................. ;� <br />Total .................. Sq. Ft. <br />-'-- ------- <br />Remarks..... .r...,.�... r ................................................................... ..... .... <br />���:.... �._ ��",..'....._ ............... _...................--- <br />............... .. ................. / <br />............... �..5�....`.�_�=.... ......_��............... :............................---.._. <br />OrderRecei��ed ............................................................................................. / <br />\Vork Ccm�leted ...................................._......_....._...................................._.. � <br />Fu: em.m <br />