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w. [ seem 3 t <br />$. ]. }rieF.e <br />C TYERETe�--Water Dept. <br />p ication No. . _ l _y(� Date--/f------19-��� <br />Install.. _ — - --inch water service pipe <br />For!.•c. --- ......... ----------- <br />... <br />1 <br />Lot. ------ <br />Addition --------- ai•------------------------------------- <br />Remarks fLGr:,"' <br />•-----•--- ,--•-----•------I---------------•------•----- <br />- <br />< C ' <br />.Sul ilnl � Pet <br />W <br />._.__.____ ft. .__.� <br />..___... I y7 ..._._. __._ <br />USED <br />Lead Connection Complete <br />Saddle Complete <br />z-� _____Pipe <br />Service LOCI. p <br />Service BoxT--------------------- <br />.J+-e'. <br />--------------------------------------------------------- <br />Na Hours Labor_________________f4__ Cost:?" --------------- <br />Cut in ------------ Pavement___..__...:X.....___..._ <br />-I--_Sq. Ft. <br />-------- ---- <br />a <br />Total ---------------Sq. Ft. <br />Remarks ------------------------------------------------------- <br />----------------- <br />---------------------------------------------------------- \ <br />Order Received _. - --- ---------------------------- <br />Work Completed------------- ----------- -----For-;,; <br />