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1�PriehNyT-41of I <br />UP <br />Application <br />1 ✓ <br />ERET -,Water Dept. <br />Date...!1....:.:......._ ............ 19"! <br />,...........ch water service pipe <br />For .. yl.l Tc _�c ./. r...a........ ........ : ...:....._ . ........................ <br />On.................. .(c. .. ..........._/��.`.......^ ..-. Street <br />Lo:.................,.7...................................... Block No........... <br />Addition ...................... . ... <br />Remarks . .:........:.............................. <br />.........................:....... <br />Rema <br />Superintendent <br />LABOR AND MATERIAL USED <br />Load Connection Complete <br />Saddle Com.lplete <br />....................................................................... ripe <br />Service Cock <br />Service Bo% <br />Order Received.........,., ....... ............... ........ <br />Work Completed ............._....._..._....... <br />Foreman <br />