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/8of/ ✓" /p/^/ �Ci <br /> W. D.FORM i ACCY. I\TO.l.(..}.' -�••�•G••�• <br /> � ' CITY OF E'v�°RFT7—Water Dept. <br /> / � �� , <br /> ApplicationNo..l.:k�.L.C.L'.l.i.... Date..��_l;�C..�..�.r._�...5-.�..--.......19........ <br /> Install................................ in�li watNr service pipe <br /> Owner--...--......_---•-..._.........._..... . ......... .... '-. . . . . . ..........�............. <br /> . •- <br /> ...... .. ...... <br /> Address.........;�.�.�..��./..-:...�.l..:l�...�?...... ...T.::.::G.cY.Z<4.�.:`4i..,7�1.1.:.......... <br /> Lot..............................................................Block No................................................ <br /> Additiun....................................................................................................................... <br /> ontrac or..................................... <br /> ......................................�--........... <br /> ......................... <br /> Remarks.�....... ......:..................................................................................................... <br /> ��' ......................................................•---....................................... <br /> ................(l.--6..1.;1.._. <br /> ......................................................................................_..............---.........._................ <br /> Amt.. ..... ......--•........................... <br /> ....................................... ........---�----�---......... , <br /> Rec. o....................-- <br /> �'ti��,u� <br /> J.�:............."'................ <br /> BY"��� � � � � Superintend�nt <br /> -•-.................................................................... <br /> ....................................1..�..�:.........- <br /> ...................... .........................................................................�--�--............................... <br /> ............................. ................................................�-�---...................................---........ <br /> .................................................................................................................................. <br /> ......................................................................................................�--�---............_........ <br /> ............................................................................................................................. <br /> ................................................................................................................................. <br /> ................. ......................................................................................................... <br /> ShopRemarks.................................................................................................�--....... <br /> ................................................................................................................... <br /> ........................................................................................................................... <br /> ...........................................................................................��---.................. <br /> .................................... ........................................................................ <br /> ................................................................................................................... <br /> ................................................................................................................. <br /> ............................................................................................................ <br /> ............................................................................................................. <br /> ............ ...... <br /> Work Compleied.........._...................... ...................._................ Poreman <br />