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� � , - i 't-���_v.,.�-rA l��..- '.- .. _ � i 1?l y, <br /> 11'.U.i'orni J�-I500-F..P.Cu-G-2G-:� <br /> �ity o�E��eiett�Wnter Depai�tment <br /> - �CATION FOR Wt1TER <br /> All bir�dcs mu�t bc fi�led in or crossed out <br /> I:c c rc t t..........._....._l...�.�:..�...............................19 P.�. <br /> 1'O Tlili SUPfiR1�11'L•'NUCN7' OF' THI \VA'CF.R DGPAR7'BIEIST: <br /> CITS" UF BVP•.ItI:TT; <br /> i hereLy �iPP�S' for thc usc uf �;atcr in a��eordance��•ith the rvlcs nnd rrgu- <br /> Inlions o[ thc �Pnlcr llcpnrtment. :ur pw�pases :md !is!w�es stated bclo�r. <br /> Uuring thc limc lhnt nn}' nf Ihc n�.rtcr mains mny� Lc h�l:en uP L�• rcason <br /> oC nn)• iwprocemenrs r.uU�orized bv the Cit}� oC F.ceretl, in or of nny etreet or <br /> ❑Ilep in �chich thec may hnce 6cen Inid, the City �vill not be ��equired to furnisU <br /> wnter during lhe progress u[ sucli improrements to any cmi:� mer wliose supply <br /> m:iy lhus Lc cut off, or('be)liu/bleG for any d:unnges for its fn �ure so to do. <br /> I P ` .A...1. / '?. .-� � <br /> A i Iicnlion Au._.. . ..... ..........:..... � < (. ?. . <br /> Bloek.... . ...... ._..... Lot . .i L ._ _ . .... Add. ._._ . . .. ._ .... <br /> xa.. ... 3 �z7 _�.�.-�.�•—�� ._.sc«�c <br /> _. __ _ _ .. ......... _ .._ _ <br /> / 7'he �vork to Ue c��cuted by ... � .� ... . � ..Plumber <br /> / /��_ <br /> /y- iSinte size of Lnp � � <br /> �.'...�:_Tup to Uc m�crtcd m lhc mnin. <br /> ...�..........R'ntcr clnset <br /> .....�.........BnN� . � �. <br /> � <br /> .......Urinnl � ./.. . .. <br /> ..._�::......Plni�i L�ucet insidc <br /> .....-.....lide wnik �cnshrr <br /> ._.../.......ilose bit outsidc <br />� , .._ .,.......FIose 6ib tor Uuilding purposes <br /> __...s...._[Iose bib insidc <br /> __.._ .....I3ib for stnblc contnininy�....._............stall.........._...... � <br /> ......_ ...\umber of prrsons in fnroily <br /> .......J..~..NumUcr of raoms in building ,� <br /> The premises nrc to bc used ns n.._.. ._..... rJ....`:=,"�1-.._.._..._..._.._....._...._...... <br /> � <br /> The owner of the premises is�/.(.�._�J.L�.i..::..-t..c.s'.::_.............:.__.. ._. . <br /> Thcngent is......................................(L......................__.................... <br /> ............................. <br /> 'Phis nt�plicntian, nitho�h s�r,c��linll not bc Ui�ling upon thc City, untii <br /> uccePted b3 he Supermtee nrbf the 1�' r Depnrhnent <br /> Signed..�.�.ri,f.�Gj U"�..:j� ).... _.. Aprlicnnt . <br /> Acceptcd...�?...'.�i/.._..1!12/7 IIy���'[/�ii� . . ...../ <br /> � ! upenntrnd.nt <br />