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Mgr)0o� <br />W. o FORM ] <br />Z:ITY OF EVEREeri -Water Dept. <br />¢arm! l % /Z/D <br />Appitcation-No....................... Date...............................................19..... <br />Instal inch water service pipe <br />For................... <br />....................... . <br />On...............Q..Ct-.................................................... _.._... Street <br />rM------------ Block No ............ ................... .... <br />Addition <br />Remarks <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />Superintendent <br />No, Hours Labor.............................................. a,os............................ .... .................. <br />Cutin....................Pavement.................... X........................ ........ ...... ........ Sq. Ft. <br />................... X........... _...... .... .. <br />Total .......................Sq. Ft. <br />memarn::.................. ................................... .......... .. __.. <br />...................................................................................... ........................... <br />OrderReceived........................................................ ..................... _...... <br />Work Completed .................................................... ............Fore........an aa..n <br />..... <br />