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sEkvicr_ <br /> APPI.. � �Q� I (�I1Y OF EVFREi � OROER NO. <br /> No, � � <br /> APPLICATION FOR WC.TER SE��VICC �I� p� <br /> DATE,C/ � -�Bo-3_. <br /> � FIXED p0 " <br /> W. O. <br /> � DEPOSIT �� � No_'- '-------' C <br /> s ———' " _ <br /> 3ERVICEIO///Y���ADDREB!)��/---�/ /y-�"---�Jf___eLK.---LOT_�����='" '�� � <br /> ��-�..sc.L'GG . _ _-'__ .GONThACTOR._.-- .-_ .----- •• <br /> OWNER _ _ _ j_ _" ___._ �-• �- <br /> A �/ � <br /> /, _.._-_ ___. ____ __ � _.. <br /> INSTALL����METERED SERVIC�___-- ---- - ---- --�--'""-"-��- - ' <br /> N � <br /> I HEREBY APPLY FOR TNE USE OF WATER IN ACCCPDANCE wll:i TME /�7 � � ��i �'�� <br /> OflDINANCES AND PO_IQES OF THE WATEH OEPANTMENT NOIY EXISrING B�GNt:D: 7C •'.C-LLdCQG=�-r-�"��"���� C C <br /> OR AS SAME MAY BI NEREAFTER CMANGED. <br /> — w ���,�� 2 Ih. i j PRICE I AMOUNT C <br /> MATERIPLS J C <br /> I O 3 <br /> PIPE COPPER--GALV.•-STEEL__ _ I r <br /> __ -._'_..._._.-' _-"_ . __ -_ --} _I_- _ - --1 a. <br /> I ^ <br /> m <br /> CORPORATION __—__- -- — � <br /> ___ _-__._. _-__._.__- __'_- I I � .Oz <br /> GURB COCK OT — — -- --� C <br /> _-- — I r S <br /> SERVICE BOX PLASTIC -- C 1 _ _� --- --- — � �- <br /> _ '___-- � -i v <br /> — � <br /> METER VALVE -_ _. .__ . __' _ —______�I __ __. - - -- - _-_ '� <br /> O :� <br /> METER No _"_.. ._-___ . _ �_ TYPE__ .- __ _-I� _ ,f — __ _-I ._ -_ _- 'ni� <br /> SMALL LARGE � � <br /> METER BOX CONCRETE ___ -- ---'- _ <br /> — --- . _. .__. _.— I m F <br /> � <br /> � — --- � <br /> -- ---- - - �_--j- -- � � <br /> � � <br /> —I _ 3v <br /> m <br /> _ I I - -- -- z �� <br /> --i r <br /> — — — " <br /> -- --- --- ---I �— —_i_ �._— ^ <br /> -- ----- -- � I � <br /> � ON <br /> OFF SUB TOTAL <br /> �ATE INSTALLED: r7 � -_,�� I f ' <br /> 1/' _- 1 <br /> N011R5 PATE <br /> CODE I L B O EOl11PMENf PEhTAL � <br /> —� Gy,2�'�AL�'�---i � _ _-- -- �. <br /> -- - — _ <br /> �il-- — ---" --------- I--- --- — -- <br /> � -�����o-� �- -- --- _-�_ <br /> � --- <br /> - - - --- �-- <br /> ___ _ -_ - - --- - --- -- <br /> , <br /> — TOTAL <br /> REMARKS: -� � - -- -� <br />