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�' ' t; nf�,',F <br /> •a�. n. i�,�, . i.;eo a-i- �c.r. :z`�,. <br /> CITY OF [:VCRF7'T==Nater Department <br /> Ap�sYication f�r Water <br /> :111 6lanks must bc fillcd in or crussed nul <br /> F.vcrclt.-�QJZt, '_�T _-__..191 O--_' <br /> r "" <br /> 'f0 1'llli SUPIiRINTHNllIi\'I'O�7'HG NA"PIiR UIiPAR9'\11:K�7', <br /> � CI'll'UI� fi9Eltlil'T: <br /> 1 here67 apply (nr the use oi�rater in ar.cnrdance aith the rules and regula� <br /> ti:nu nf 1'he 1V:LLer Urpar�in•nt. (or purpnsas and listurrs stateJ bclo�c. <br /> UurinK thc timc Iiia� :mp n(the wa�cr mains m�y he Inkeu up bY reason uf <br /> :mv imPrnvements autnor.:ed by the City n;licen•n,iu or n( any slreet nr allcy in <br /> �rhi�h lhey nt�)'have been laid. th��City �rill nut bv mquired tn lurnich u�a cr durin� <br /> Ihe yrntirecs nf such impru�•rments lu:mp consunu�r whnse supplp m:�c ihus be cut <br /> olf,or bc liable!nr any damogqcs tur iis failurr rn In Jo. <br /> ApplicnYnn Nn.'_'__�'. L'�__-�.. . _. <br /> Hlock . _�_' �/r�� Lul.."�:-"�g'`. '-_.'�Add_�ypa <br /> �'o.—. .. _.�O.��T ULG�Q��t..��-0..S{J.Strcet " � <br /> .___'. .. ..__ '___' ' ____""_ _� �' )"'._—__}_-_'"'�_'"�_'""_""_"'_'._"'_ <br /> Thc wurk to 6c crcculed bp._...(it/�-¢Jv�rzr-eit""_'__ .' PlumLcr <br /> Stalc�izc uf tap. <br /> �; Y r. <br /> _'fap to be ins�•rted in Uic maiu. <br /> " L . � <br /> __'_J""R'�ncr clucet . ._ <br /> _.-�____13�th r.�.,5� �".f E=.,. <br /> > � � �. <br /> _. .___ .Ufln:l� '/li` 1 7 '�. <br /> �' 7,� '��.. ;. <br /> _.Plain (auccl insid�• � .' .. <br /> 1 ' ���'�� <br /> ' ""Side n�alk washer � �� � '��/�/ i ���-�::. <br /> ..Ilusc hib autsiJe A� � - ° <br /> ____ '_ 1 �. �i 1.� �' <br /> .__._. ..Hoscbibforbuil,hn�,Purp,scs �� CP : � . <br /> --__Hnsebibinside \�� " :�.' . �V� . <br /> . __I3ibtorslablecontainin.l ' _. _ "'��..�•: . <br /> . .__. " _ ^� " <-� .�. <br /> "`�,�j � ' <br /> ._..._'Nwnbcr n(pers-nns in family �^`�_.�_�.l• <br /> ...5___'Num6cr u(roomo-iu building //�� 'e - <br /> '1'he Prc�.tises are to be used as/�a "___.Y_l...Cc.C._�e��h<LQ_"___' __"' <br /> 'I'hr a�cncr o(t hc Premiscs is/.�-dL�/'d=-�.-J�-f-[..�'_L f.!"'_""'__" <br /> ! <br /> 7'hra.cnlig .'___.__"_""'___.. .'_ . _ " <br /> ____""""_"""_'""' <br /> This :�pplicalion.allhouFh signeJ..;hall nul 6c biuJing up��n the Cily, tmlil ac� <br /> trplyd bY 1'hc Superinlendent uf�he 1Vnler Urparlmrnt. <br /> ��/ 9 ' <br /> Signed _""'__(�' . _ . _' _ APPlicam <br /> "'_"_' <br /> ArcePlr��. ���'._ 1!Q .,: - _ � ,. <br /> .i t \ . .., i.� _ i <br /> V / <br />