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O <br />w. o, ro.�wlS� � 3 <br />CITY OF EVF'�ET�['„Water <br />Dept. <br />APPlication No.l..':.:1..���.�i.. :.'. Date..........._ :�_... i <br />........................ . <br />7nsta1l ........... .:_... .19.:c .� <br />For ._.:,:�./.�<:::�.... --�.. %� j'�.:�inc w servic P P <br />.� . .. ......c<./._._..�.. ,..r_.: h... <br />ater ' e i e <br />r, : - =, -.t.::....._ ............._...... <br />On ........A....L.:.:'..1.....:.:.�c:.::..:._ �:::z..`....... �� i r, <br />/ <br />............../..................... Street <br />Lot .............................................................. Block No.................................... <br />Addition ....................- <br />- ......................_ _................................... <br />Remarks .................................: <br />....................... J.................................. <br />; _ ........ <br />...................... , 2. <br />............... ,,.: � <br />..........:...... _...........:....:�..:� <br />........................_ ....................................... <br />....................... <br />................................... ._ .................... <br />Superintendent <br />�z <br />LABOR AND MATERIAi, U9SD <br />`. No. _i Sizc I <br />::;:�:::::::;::�:;::: I Lead Connection Complete <br />...... <br />.... ...........................I Saddlc Completc <br />......._...__. rr <br />....................... ..I Scrvire Cock <br />Seraice Box <br />....................... . <br />No. Aow�s Labor.._........_ ................................ <br />Cut in........._...._...Favement ....................Y...._Cost............ <br />....................X........................ <br />. _. _............ _X ........................ <br />_.. <br />........................Sq. Ft. <br />....................... �� <br />........................ �� <br />....................n........................ <br />_'_.�� �� <br />__--- —_'�__-- =--- - --'- Total <br />—_._--- ........_.....__.....Sq. Ft. <br />Remarks....................................._ ------ <br />_ . ................ . <br />....._ ..................._.._...._ . <br />... .. . <br />- .. <br />. ... . ... ....... .... .. .............................. <br />............................ .................. <br />Order Kecei��ed ................................................. <br />.................... <br />\VorA. Complcted .................................._............... ...... ..........._.. <br />_ ................ ... ... . . � <br />Foreman / <br />