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.._.__"'--<r r�--:s si �-� - �� <br />-.. . <br />tC b.7'orm � 1GIIn--l.r.tb.-5-"s..l ' <br />City of Evei ett��� ater Depar�tinent <br />APPLICATION FOR W�,T�R <br />elll blenks mc�t Lc f:llcd in or crossrd nut <br />L;verett�.......... _........._....._ ................_ _. _._ _...... _ _.. _....1!�!. __. <br />PO T(Ili SUPEIiINTtiNDENT OP TIi:: \\'ATER ll�PAlc7'�tli.\"C: <br />CITF OP PVEI:tiTT: <br />I bereLy npp:y inr the usv ef �c:rter in accord�nee �cith ilte tvlcs nr.d regu- <br />I:Lions of thu AVntcr Departinenl, for pmposeE and fir�urus staLed belo�v. <br />Duri»g lhe time Lhnt nr.}• of thc •,eatcr mnin� may bc taken up by rensun <br />oi anp imP�•ncemenls aulhori::c1 by thc Cily� of I;��crett, in or of miy :treet m� <br />;J'e;; in �ch:ch +Ley ui::}• hn��e been Inid, Uie City �vill not be mqnired to furni�li <br />�c. ter dm'in� tLe progress o( such im7�rovemente to nuc conEumer �vhose sup�:ly <br />m:iS lhus Ui� c�t ntf, or bc liaUqlo fm• :,ny d:v.�agcs for �its failurc cu to do. <br />App!icntion A•o._.._._g.7....l.........._.... <br />Blocic..........._.......__....._._...... Lat ................ .. _ .._.. _.. ._. Add.. _.... . . . .. _ ... <br />No.._.� __�.. ..._....._ _..........Strc�l 1 � ;' �-. <br />. .�crr4............ _. . <br />�� �-o �J � � � � � <br />\:.i.. _„1 . <br />'I i � o�orl: to be execct�d b�.__. . . . _ .. _.._ _...Plamber <br />Statc eixc oC tnp. <br />....4�.�......Tnp tu be inscrted in fhe mnin. <br />_......_......Nntcr closet <br />..._.._.._...4ath <br />... _...........Urinnl <br />� � �- � <br />.K �'�� � <br />_... .........Plnin tnucet inr.idc , � �- ,��� �; � � . <br />�L� `: <br />.............Side wnll: tcnshcr /� �r'. <br />.. <br />...............Iioec Lib out::idc ; t <br />._.. _......_Hosc biL for buil,ling purpn: �,.: <br />. .............Ilose bib inside <br />......._......BiL for stablc cmdaininP.._... _..........stalL ..............__. <br />.._...._......NumUcr of pe�sons in famil,v <br />._ .............Number ot room.=. in building � <br />Thc �:�•er.iises nro to t�c used ns a. y" "� ��� <br />� , ... .. .... _._.. <br />The owner of thc premisee is_.._G�-''� c-' �:�--i_ '�.j::y_ �--9 . <br />Theageut is.........._ ...............................__............__............__ y <br />.......... _ ........... _ .......... <br />Thi� upPlic:ition, nithnugh eigned, shrJl not bc binding upon tlie City, until <br />.��t�.�d Uy th� Su�urinte.dcnt of thc \Vnier Depnrtment. <br />Signed ... ..... . ......... . ._ �f .: � � licant / <br />ri��d.... ._._ _. ..... _ . �2.__. I3�.. � ' ( <br />P <br />. .... . ... ...... <br />tendent <br />�y _ - <br />