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�, <br /> �, <br /> APPL����� CIT`i OF QVERETT � . oRoeRE NO. � �'- � q I <br /> No. <br /> APPLICATION FOR WATER SERVICE <br /> DATE�w'�'-�—�0�ry <br /> � FIXED o l� <br /> 0/ W.O. <br /> � DEPOSIT �_ No. / <br /> /- �.�, �y�2�-�-�N�/ <br /> $ERVICE (BY ADDRE • -� .�f�'����- BLK._ LOT_,� � <br /> /��=✓`�W �/.%�L'� <br /> OWNE GONTRACTOR - <br /> i� <br /> INSTALL�—METERED SERVIGF ---1� ����i{��^ <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORD�NCE WiTH THE � r '��� <br /> OROINANCES AND POLICIES OF THE WATER DEPARTMENT NOW E)t�STING B�GNED: X- � '�=-+c=t <br /> OR AS SAME MAY BE HEREAF7ER CHANGED. <br /> MAT[RIALS }'� IN. 1 IN. � 2 IN. � I PRICE AMOUNT <br /> p�pE COPPER- GALV. -- STEEL � <br /> CORPORATION _ _ - - <br /> CURB COCK OT _ —�— �— <br /> SERVICE BOX PLASTIC -- G 1 I _ � <br /> METER VAWE __ -- -- - � <br /> METER No. _ TYPE_____I K _ __ _ — <br /> METEii BOX CONCRETE SMALL LARGE __ _I ____ — <br /> — —.-- -- —II �_— <br /> — I �— <br /> _—' I <br /> — _ _— I I <br /> I �- ON <br /> n � OFF SUB TOTAL <br /> DATE INSTALLED: I �. 1•Z . � / <br /> CO�E <br /> I LABOR AND EQl11PMENT RENTAL I HOURS RATE <br /> I _ _ �/,� � TP/7Vla / �_I� <br /> � 13�r'JJ/v�7 l-� \/ � � __ <br /> —� �=` ���—I I— --- - <br /> - -- 7����� � <br /> � �_ -- - - - -- <br /> -, --� T;t t�t�r._� _ <br /> - � <br /> _I _ - _ - - -- <br /> -- - --- I - <br /> i <br /> — TOTAL � <br /> _ � <br /> REMARKS: . ___.-.____-._. .--- - � . - <br />