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<br /> CITY OF i�TERETT--Water Dept. , _
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<br /> Application No.�.J-�:) C� .� Date......:�...�..._...�....................19......
<br /> J,. ,�nstall.';�.. ..... ............inch water service pipe
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<br /> For � �C..x. :/... j , ............
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<br /> Lot....................._�.'.`........._.................... Block No......_�..c!......................
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<br /> tiddition .............................................................................
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<br /> Remarks ...............�'.................................................................--�--..............
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<br /> _" _:' �l�- r'o.:• LABOR AND MATERIAI. USSD __
<br /> No. i Size I ----
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<br /> _......................-.......... . ........... T ead Connection Complete
<br /> S�ddle Complele
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<br /> / /�' Scrd� Cock
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<br /> ....................../............._................ Service Box
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<br /> ................::�........:...:.:.............._�..�.-�............J.......�.............
<br /> No. Hours Lsbor..............................................Cost...................................................
<br /> Cutin..............._...Pavemcnt....................X........................ ........................Sq.Ft.
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<br /> , _:r,: . .............._X........................ ,.
<br /> �C................X........................ ........................ '
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<br /> ;'- / Total ......................_Sq.Ft.
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<br /> Remarks.........., �
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<br /> Order ?teceived._.. .................................................... .,,..._......_.--..............
<br /> \Vnrk Ccmplcted_J1.:.,!.,::....:'.:.........__......._..:�_.'... :..:_.:...:..:...::..._...._.
<br /> Foreman
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