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I <br />�W. D. Form 0 1560 0.1-17 C. P. <br />CITY OF r-VERETT—NVatcr Dept. <br />ApplicationNo.5-&b_ Date ---- -__ .S_----- l9oz- <br />)i�� �--' ,Install_____ _�lr____ inch water service pipe <br />For-------.(,ilr7- <br />/- c7 0-Al --- -----------------.Street <br />Lot.--------------- -------- Block N'o•-------------------------- <br />Addition--------------- --- --------------------------------- <br />Remarks----- ------ ------------------------------- <br />---------------------- <br />- - (--�------------I-----------/-- <br />'�', <br />---v, Su etid endent <br />LABOR AND MATERIAL USED <br />o. <br />�s/�1qr_ <br />---/�'__ <br />Lead Connection Complete 4. <br />-__ - <br />�'- <br />Sad.JJly/77C*nnpl e <br />---a. <br />---- <br />--- J '- ... ---- '--------ripe <br />�.--- <br />. <br />Service Cock <br />Service Box <br />-------------- <br />______ ______ <br />________________________.--_.-_-__._-_.---.___.-____-___-.____-_. <br />______________ <br />____________ <br />_____ _______________________ ____________________________ ------- <br />No. Hours Libor ------- :9-------------- ---------- .-___._ <br />Cutsin___.____._._.. <br />Pavement .......... X-------------- --- _---- .... Sq. Ft. <br />_- -------------- •• <br />-- — — --.X.--.._..-----' <br />--X----------- .� <br />'rotol. -----------.Sq. Ft. <br />Remarks--------- ---------- ---...---------- ------ -------- <br />---------------------------------------------------- - --------------- <br />Order Received <br />Work C•-mpleted-_P_'3---------'--- ----�, --- <br />,Foreman <br />