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/� 3 ' � �'���`' <br />. o. .�f� �s 9 � � �° <br />�� CITY OF LVEi E7`r'--�'ater Dept. <br />, _:. -1 1 ' / .......................�9...� ,� <br />A;�plication No. .%.:: .::.:.:.. _/.� Dute........._�......... .. <br />Inctall ...............................inch water srrvice pine <br />f'' // <br />F'or .....�.�-.!...,.c.:......C...=._Cz�s............ 5........ <br />� / � . , � / �.� ......... ...._ ......................... <br />On .............Gt.._ .%�- .�-.......... �:f �:..C_.f;r....:.:::'.1......................... treet <br />r„i ---......... Black No ..................................... <br />+r',dition .............._............................................................_........................... <br />iicmarks ........................... .-.......................... . <br />........................................ <br />/% - ., . �. <br />..............._............................G-.F•.:�-�...:.�iz.............................. _._--......_...... <br />� LAROR AND MATtiRIAL USED <br />No_ ��ze I <br />__ _ —_r -- <br />............._....... ........._........_..I Lead Connection Cnmplete <br />....................._........................_..._ Snddlc Complele <br />....................... <br />fl..-- ..............__._ . . .__..................._........----......_.... <br />. _ ........ _.. Scrvicc Cock <br />........................... .... ..... .. <br />._ __ ........ ............. Ser:ice Box <br />Superintendent <br />........... ..............................._ _............ <br />No. How�s Labar_._ .........................................cosc......_........................................... <br />Cutin..._.._.._.......PavemmL ...................C...................._. ........................Sq.Ft. <br />....................X........................ ........................ <br />�� <br />....................X....................... ..........._........... <br />,� <br />....................X....._.................. ........................ .� <br />Tatal ..... ... ......Sq. Fl. <br />__- ----'--- <br />Remarks........... . _...._ . .............. ......... <br />........................... <br />__ ....................... _....... .................._ ........._.._ . ..........--........ <br />............. . ..................................................................................... ................ <br />lJrder Receircd _ ........................_............... <br />\Vork Cmnplcted.........._ .....................___......_....__.............................._.. <br />Forem n <br />