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0. i Pq1�A[ ]��/+ �O � ' y <br /> W. D. IOpM ] � � <br /> CITY OF L'VERET'I'--�Jater Dept. <br /> , , , ,; ,� � <br /> Application No....:.....::.......1:.. Date.............................<..................19...... <br /> Install..........y......._.._.._..inch water service pipe <br /> For ........................'...:...............::.----............'.. <br /> ..._........................................... <br /> On .................:.............:..:: ._........:....__.........:..........:...........--'-_.'=... Strect <br /> Lol....................................................._....... IIlocic No........_..._.....................-- <br /> :�ridition ...................................................................................... <br /> .................. <br /> Femarks ...............�.:............... .........................._................. . <br /> ....._.._............. <br /> .� -:— - , .r � / <br /> �.' -:.....:....^.».:.. ' � . .. <br /> ................................................ .:_r.:...................... <br /> """.�� .....��..... <br /> ) ' <br /> ' . r .� .� . . , <br /> , . , . . � <br /> .......... ....__...................::.!.._.......:................_...............................::._............."'.. <br /> ..................................... ............................_................'""'............................_... <br /> . .' l� T ;.�� . i <br /> � , <br /> . ,..........,...�...............�. . . <br /> ......"'.............._.............:<.......:..._....._........................... <br /> I� � ��'. � � Sliperintendent <br /> —_-- — —c _n-r�=� — � . <br /> � - LA.^,JR AND 11iATERIAL DFiED <br /> No. i Si2e � <br /> — --- <br /> ....................._.......... _..............._ Lead Conneclion Complete <br /> ..............__........ ...... __.............. Saddle Complete <br /> _..__...............f t. .. ..................... ................_......... <br /> ........_.......___._.. ._ . ..........Pi pc <br /> ......................... .......................... Scrvitt Cock <br /> ........................ ............................ Scrvice Aox <br /> . ........ ....................... <br /> _..................._.............._....._......._..........................._.........__......._ ..... <br /> .__.. _..._............................-......... <br /> No. Hours Labor....._......_._.....__...................Cost.................................................... <br /> Culin.....___......_PavemcnL...................X......._............... ........................Sq.Ft. <br /> ....................X........................ �. <br /> ......._............... <br /> ...................X....................... �� <br /> ........................ <br /> ....................X........................ „ <br /> ........................ <br /> Total ......................Sq.Ft. <br /> ------------�--_._ <br /> .-- -- �. -- — - <br /> P,em arks....._....:....................._...............:'_......._................... <br /> .............. ...... . <br /> _ ......................................................................_--_........................_.............. . <br /> ........................................... .._..............................1......------=- <br /> ................ <br /> Order ^cceiced_........_.._......_ _.._...._......... ......_:......... <br /> ............:... � ... ........ . <br /> \l%orl�_ Cmn��lctc�d........_.___.__.......................'.... -. <br /> - . .. .................._.. ...._. ._.. <br /> Porema\ <br />