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'f/��N�(�� u � 3 - '1 � ` C N r Y.i �r G.!� !r!/ <br /> ' J <br /> ! � <br /> w, 0. Fcrm 4 I500 �-I-I]C.P. ' ' <br /> CITY OF Ei'f?RETT==Water Department � <br /> Application for Water � <br /> Ail 6lnnks mu,t bc fillcd in nr crossed out <br /> s,�����. ---- -- - -- -�Z`f --- »,?_L I <br /> TU TIIE SUPIiRIN'1'li\UIiN'P OP 7'lIL•'WATBR DIiPdHTAtIiNT, � <br /> l'17'y pF' H`i HRtiI'T: I <br /> 1 hereby apply fnr Um u>e nt water in accordance with the ruies and reK��la ; <br /> tiun;u(Thc 11'ater D�parlmen4 (ur purP�•�s and fictures sWted below. � <br /> Uurin� lhe Iime Ihat :my o(lhe�eatrr n-,ains ntay be [:,ken up 65' rcason nf <br /> :m� imurovemenis aulhnrized bc Ote Ciq•i,f F,ver�•It.iu or of anp s�roel or alley in � <br /> which they mtY Itavr bt•pp laid, the Cil)'�vill nut hc requi�ed to furnish water during <br /> the nrn�;ress nf auch imprwemcnis lo mip consumcr �chuse siq�plr map thus br cut <br /> ��h,on c� liablc fnr anc damagc.ior ith failure so to Jo. <br /> APPlic�tian Nn."'_7'��. �_�! <br /> __"'_' <br /> Hlock ._._.'�..�.-Z7i.__l.nl�_C:S '�'_"_Add <br /> . ._. ___..__....._. <br /> Nu._.__�_�_1 � _.�-q—`..__'.Strcet - <br /> _.-.. .____ __.'_ ' _______ . /r-'__ <br /> '1'hewark �ohecsentledb}' . ju__ze_.CS_g�-+—r'�>„"'__'_' Plumber <br /> $tatc size u(Inp. � <br /> ./?-=-"'TaP to be insrrteJ in the maiu. <br /> .___�'.___11'ater dascl <br /> "_�_'_B:uh � . <br /> ___.._._ _Urinal <br /> ._-_.__.__Plain faucetin=ide <br /> -.--'_____Side walk �easher <br /> .---"'_.._Ilusc bih nutsidc <br /> '--"'_"Hose bib fnr 6uilciiny� pwpnsev <br /> . -__HoscLibia�iJc �;�,�\ <br /> -____'.__I3ib(orstnbleconuining.____._.___slnll._. __.._. ' <br /> "'_.'_"Numbcrnl persuns in fa¢iily <br /> "'S"".Num6er o!rnom.iu huildinq <br /> 'P6c premises am lu be usrd as a""""""_"'_"" <br /> / ' ' .__"_"'__" "__. <br /> The mvner o(the prentises is __'1r1/Q��_r_`i. _ yj,1�1J_. <br /> "Phc a!ent is _____.__..____'_._.'____.___ <br /> ..___ __.____ <br /> "1'his application.althuugh signed,shall nnl bi•binding upon the Cih�, until ae <br /> cepted by 7'he Superintendent of tl'�SVnte �part acnt. <br /> �t/ 9 �-� <br /> � SiKned____'_�Q �-.� ��Y� 77��Y . <br />, APPlicnnt : <br /> " _ '.'_____.'_ <br /> I :\ccepted����. 1',g2 6� <br /> - -�- - --------------------- % <br /> i .,,.,��-,��:�.� <br /> � <br />� <br />