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/ 91�8 7 APPLICATION FOR SERVICE SERVICE {�I� 6 G 2 <br /> APPL. ORDER : <br /> No. CITY OF EV'f,RETT WATER DEPT. �T�^_ / . _ �;,? <br /> � .�jL , ; C � <br /> / %��' . <br /> � ��XEa <br /> ) _ o�, w. o. <br /> � DEPOSIT g�-{�. - No. -- <br /> �/ / � <br /> � �J / �,Z - � L�%' ' / __OLK. LOT- -ADD. <br /> SERVICE (B ADORE56)� <br /> ��//( y ! ' �--.�'L-•">`'� <br /> OWNER= "�'�'=`���L C ��.L: <<.i�� —CONTRACTOR__ - <br /> � rL�.T <br /> INSTAL�/� MiiiRE� SERVICE -- , <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE 141TH THE ,� � j <br /> OROINANLES AND POUCIES OF THE WATER DEPARTMENT NOW E%ISTING � c��,"L ' ,J�: �i7 _ <br /> OR AS SAME MAY BE HEREAFTER CHANGEO. slGNeo: X=.-C �� <br /> MATERIALO �,i IN. I IN• I � �N• I � PRICE AMOUNT <br /> / I I .�G I /L��;�/ <br /> p�pE COPPEZ•-GALV.--STEEL � � II .JI/� <br /> CORPORATION � � I <br /> CURB C �_ Q, I � �� <br /> J —� l ��D <br /> SERVICE BOX PLAST�-• C I .— I <br /> METER VALVE — ---- - —� <br /> METER No. TVPE: __ I �f — -I I <br /> _ � —— —_ — <br /> METER 90X CONCRETE SMALL LARGE _ <br /> �ea_� �' - — — /i f�� <br /> Il � � <br /> — —I — �_ <br /> _ I -- —I— <br /> — -�—'I- I <br /> � � � <br /> I � oN .�� I�� <br /> SUB TOTAL <br /> DATE INSTALLED: ,ID / _� �.; Q' OFF �I�� <br /> LAOOA AND EOUIPIAENT RENTAL � HOUFu RA(E <br /> COOE � � � l.%�� � �I 1/�� <br /> �Q.7-�2t-� --- — ----- -- I �--I--- <br /> � - ^. ;7,) <br /> � 3_ 'l ,�Ii � t <br /> r� =(�� - - I� II I <br /> _ - � II__i_ <br /> --�, �� ------- _--- ----L'�- -`.� � � _ <br /> �`�� I TOTAL 5�I/J <br /> !� � I _ <br /> REMARKS: ---- —� <br /> —__ _._—-_—'- <br /> � . : ' r �;� J . . . . _. _ _ _ .. .. _ . _'—_'_—_ <br />