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- �e. o.f<<�� . �soo a-�.-i�c v. <br /> CITI' OF E1'ERETI''Water Department <br /> �pplication for Water <br /> :\II bianks must 6� filled in or crossed �� <br /> � � c, <br /> liccrett. -.'__' _��_�_' _"'_.__19P ."._. <br /> 'P(1 "PIIE SUPIiRIN'I'IiNUIiS'f P' Hli 1VA FR DIiI'AH9'T1F:NT. <br /> �ON F.9GRETT: <br /> I hereby apply (or Ihe u.e o(�cater in accurdance�cith ihe rules ami regula� <br /> �i�.m:uf'Phu 11':uer Uaparlm-nt. (nr yurpcnes and �istures slaled bclo�v. <br /> Uw'in�;Ihe Gp1C II1.11:l�l)�(lhe o�:ncr maina mae hc takrn up 6y rc:�son uf <br /> aity imP:��vrmenls aulhurized br lhe Cily uf licerelt.ie ur ef any slrcet nr nlle)' in <br /> �vhich thel ma9 havc bcen Inid.thc Cip��eili nnt bc nquireJ tu fumrsh wa[er during <br /> Ihe pronress n(such impraaemi•nl}�u:mY consumer e'huse supph• m�n Ihuc�i����� <br /> �,(f,ur 6e liablc fnr aoyQdanci�rs for iR failurr su In dn. <br /> Applirntiun Nn_.0 �d �'_.'__'_' <br /> RIocA '_"._t� _ J.ot.�6 /9— i � . .d�id_. ... <br /> • / __--._ <br /> \u..�.`1. dJ�_ �li .-t/Le.�e.�j� ..Strert <br /> '_'_'_""""_""_ f <br /> _'... . .. _.. .__"' . "_"L""....."."""___"""'___""_""_"""_ <br /> "1'he �cnrklnbec�cenitedbe_-_. _"__.___..._' '__'_____'._.'_ Plumber <br /> Stalc/��1+/zs�d tap. ``��// // <br /> .3/=_T_._'Pap l0 6c in=rrlcd in thc mnin. .�75 / �/ � O <br /> ..____�..15'�ter cinm t <br /> 7 � � <br /> . ___�_ I3aUi <br /> Urinal <br /> ..__.�J Plain laucet insdc <br /> - "91t1e��'alklvasficr � <br /> . .--� ..Ilosc bib autsidc <br /> _---. _.Hose-bib-(crbuildinRV�rl��:rs � ' <br /> ._ _._..I1oseUibimidr <br /> .'_'_"'Itib-toi��nblcconMRin'�i. .--_'._._-stall.'__ .��./��' <br /> _ NeHnHrrr+f-{�enuuxin-(ami45' `� )� <br /> __��.Numbrr nf raor.o- iu building r � . <br /> �J <br /> 'f he Prrmitics�u'e ln Le used as a ..__. ._._..... .__._.."'_' ' <br /> _ ___.. <br /> '1'hemvnernftliepremi•.�eis "'�"""_"'. ._ .__"'___'__._'._. <br /> _. <br /> 'Phc aFent is "_.. .. . .'_-""'"___' '_ '' <br /> + "'____.__' •__' <br /> 'Phis :�pplicatiun,alUmugh siAncd,shall �mt be binding u�n Ihc Cip'. ��ilil ao <br /> ccptcJ hr'1'hc SuprriNendenl uf the nler Ucpartmrnt. �.. <br /> Signed __"����:'(�Applicint <br /> � �/�.��� / <br /> :\troPlcd ��D._�.(�N�— 14y_ . � N2+:.."'". .._ <br /> �/ ���✓l±.H ur:vnie^i <br /> / !•' 1.... - <br />