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W. J. <br />Fm3 tM <br />5.J.PrieIW.1VCZ.aERETZT- <br />-Water Dept. <br />Application No------------- Date ---------- — ----------19---- <br />Inst,11------------ ---inch water service pipe <br />For - ------------------- <br />(-� .....................Street <br />Lot----------------------------- Block No-- -------------------- <br />Addition ........... ------ ------- <br />Remarks - - "- <br />Suurinundent <br />i •� <br />n r,n ewtn s.te TnnlA1. DINED <br />No. <br />— <br />_ <br />Lead Connection Complete <br />_ <br />�. <br />S,a�die Complete <br />G_._...h..._. <br />-----_---- <br />n.6_c_______________._..._..__Pipe <br />'� " <br />Scrvicc Cock <br />!_.__._ <br />.�..._.__..-._ <br />Sctvic^ Box <br />_.._..._.. <br />_. <br />J <br />, <br />a�f <br />--------------- <br />-........................... ------------- <br />- No. Hours Labor -------------------•__ Cost ----------------------------- _--__-_ <br />Cut In. ........... Pavement ............ X.............. ..... Sq. Ft. <br />X------------- --------------- -- <br />Total ---------------Sq. Ft. <br />Remarks __ <br />------------------------------------------------------------- <br />Order Received -- -------------------------------------------- <br />WJ/ <br />L: Completed.. ______________ __--------- <br />Foremon <br />