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5 ' ^ 'ebei�"]4�55—/� � V:�. � _. <br /> Vl.U Eorm) .. ' <br /> CITY CJF LV RE� � --Water Dept. ' �"� <br /> p • F_� <br /> Application No.l....�S...... Date..... .....:�"� ::. ';:� '� <br /> -•- -• • ................19----- <br /> Install. ._�.,,�,�,,,,,,,,,,,,,,�ch water service pipe <br /> For ....................�........... .. .._a!!. <br /> � ••�.6�- -.:rt_:.:..l�.''...... .........• -•-• <br /> . 2 <br /> J�� ,�� . . . . <br /> On ................._..........�./,:.........�:...L!:.2..t'�.L. �L treet <br /> _ ... <br /> Lot............................................................. Block o................_. <br /> .................. <br /> Addition .......................................................................................................... <br /> Remarks .............. ..�--................................. ..... <br /> - . . <br /> ......--•-�........................... <br /> ............................. .. ..��!'.:z�.n!.•r-n - <br /> u............ ...................................._... <br /> ....�......................._ <br /> . . ..................................................................._.............._....... <br /> ....'..:::...........:...........�.,......::........................... • <br /> . ...... . . ....... . ......... <br /> _ -•_ ---• - <br /> ................................ <br /> ........................................ ` <br /> / _....... ..... <br /> � . � _ Su r nQent <br /> -- - —_ �✓ <br /> LABOR AND MATERW. QBSD <br /> ___No. I Size I <br /> ........................._I.. .................... T.cad Connection ComFlete <br /> .............................................. .. . Saddle Complete <br /> ........1/........tc.......�.. � <br /> . ..(.�...t��...:3.(..C(�,. .......................Pipe <br /> � ............ ................ <br /> ............. ................... <br /> f� . 3!......... Ser�jheC.�ock <br /> ............... ................../.. . Servicc Box <br /> ............................. <br /> Nn. Aours Lnbor......................................... ost................................................... <br /> .... <br /> � � - <br /> ut .m_..��F-.�......Pavemc_nt......a......... .f �.!.........................Sq.Ft. <br /> . .. ... <br /> ..... <br /> ....................X...�................... ........ .� <br /> ................ <br /> ....................Y..........._.......... �, <br /> ........................ <br /> v <br /> ....................._............_......... ........................ �� <br /> Total ........................Sq.Ft. <br /> -- --- <br /> --- - <br /> Remarl;s__--... Q� -- — <br /> _.... ........__ ._.O_...�....................................................._... _... ...... <br /> ..... ..... .. .. ....._ <br /> ..... ...- <br /> ... ... ...... <br /> ... �.r.... <br /> . . . .. .. . . . . .�.... ........_......{Y.x. ....r.:).:.::fr.�:.�:.... - <br /> ... . ... ..... . .... � <br /> Order ??ecciced... ........................................_......._ <br /> .... .. ....................... <br /> l�ark Completed.. � 'C F . �,�� <br /> '� -./....:�-/............... .�.�'i-. Z' / <br /> � Foreman <br />