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� i.�n�t—�1]-i6r-f5/ � / � + � V <br />V1. 0. Form J � �� ' <br />CITY OF EVERi 'IT--Water Dept. <br />- � .,:,, <br />Applicatim� No..,��%-_:........ Uale........r :.......:.......r._....:�:�...........19.`.:..;i <br />Install ............::. :....:..........inch water service pipe <br />For.................................................................................................................... <br />%- -' � n ;'; ; - , <br />-- -'� ,:: ,r_ ........... Street <br />, <br />On ...................:.....................................::....:._..:.t:R...c....:.... <br />� ��..y....._.. it � <br />Lot ....................:=f � ` .. ..... Block No......:.:_.�:---.........--....--• <br />.. ............. <br />Addilion._......_ ...............................................................- ........................... <br />Remarks.....................:...f. .....:..............................:......................................... <br />1/ ( . ,�/., � •: <br />_ ....................... _..... --... _...... ........:..........................:.,..�................................... <br />- - - - .. ..............................._.............................__...........................--- <br />........__...._ ..................................._ .. . � ........ <br />' .... ... .. ........................._... <br />� ./ � <br />� "�`/ �7 � 1 , -r� :.. <br />1...... . <br />................. .............. .....................:................................ <br />/,- • Superintendent <br />�� . �.', <br />LABOR AND MATER[AL DSED <br />Nu. I Sizc <br />_.._.I Lcad Connection Comp]ete <br />..._..! Saddlc Ccm�lete <br />....... ........................................................................Pipc <br />....... Scrvicc Cock <br />... :icrvicc IIox <br />naFiours Labor ................._......_................Cosl.__............................................... <br />Cutin..._ ..............Pavemcnt._.................X........................ ........................Sq."t. <br />....................X........................ �� <br />........................ <br />......_.._....._.X ........................ �, <br />........................ <br />.............. .....X........................ „ <br />................ ....... <br />Total ........................Sq. Ft. <br />— -- - — �— — - ----- -- <br />Remarks..... ._...._ .............._......._........ --......_...__............. ............_......... <br />_..... _ ... ...............................___.................__... _... <br />Order Reccived._.._ ......................._.....__......-----..... <br />\','orl: Compleled..._.._ ...................................._....... <br />... ............. . <br />F'oreman <br />