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CITY OF ETETT--Water Dept. <br />Application No...../ ... ....:.. pate.....L:.f...................19..... <br />Instail................... <br />: . ..............:.inch water service pipe <br />r.::._ <br />......... ..._......,..:_....._................. .............................. ......... <br />On.........: . _...........:.....:...__......................................_....... Street <br />Lot ........ - ........... :....................... Block No ........ L/.......................... <br />Addition.......................................................................................................... <br />Remarks........... ..:............ .................................. ................ ...... <br />.... ..-W <br />..................... .............. ........ ..... ......... ................ _... _ <br />.....e..y._......._.._.................................................. a% <br />:../J:......:.........:._...:.............: .. <br />...... .... <br />�. �.... ....... _..... ................... <br />ice....... 1 5.... !........ <br />................ <br />.................. _%:._..:...... ............. <br />4 23 ^ 9 Superintendent <br />LABOR AND MATERIAL USED <br />Lead Connection Complete <br />Saddle Complete <br />........ti.:. (c::. 2.1. L..... _ ....... ....... . ............. _ _ __Pipe <br />Service Cock <br />Service Box <br />............................................................................... _....... <br />... <br />No. Hours Labor............ ................ ....... ....... . Cost ..... .......................... .................. <br />Cutin....................Pavement.................... X........ ............... ....................Sq. Ft. <br />........... _....... X.... ....... .......... .. <br />.................... X..................... I.. .. <br />.................... X........................ .. <br />Total ........................Sq. Ft. <br />Remarks... .... ............. L,.::..:......:_:.....:.:........... ............................. ............ <br />r J <br />OrderReceived ........... ___ ................... ...................................................... ` <br />Work Completed_: .................... ............. __ ........ L.s,:..C.i:.:Sr..... <br />Foreman <br />