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s 09,5 4 p <br />W. U. Potm <br />ERETT--Water Dept. <br />Application No.......................... Date ...... ......................................... 19...... <br />Install.........r:.....................inch water service pipe <br />For <br />On..... :.............................. ................... :.......... : ............................... Street <br />Lot.............. :.... .................................... ...... Block No ......... :................... _..... _ <br />Addition.......................................................................................................... <br />Remarks ..... <br />........................................... .............................. I .... .................... <br />... .. (. ..%......................... ...................................:.....................1...... <br />77 Su erintendent <br />�' — / <br />LABOR AND MATERIAL USED <br />_No. i Size j <br />Lead Connection Complete <br />Saddle Complete <br />�..: ................... ..Pipe <br />Service Coe <br />Service Box <br />No. Hours Labor........................... ............ ...... cost ....... ............ .......... _................... <br />Cutin ........... ......... Pavement ................... ?................. ........ ........... _...........Sq. Ft. <br />�'�!l/e...................X...................I..........._.._.......... <br />-7......._.._.._...X.................... <br />/ 7 �� / Total ........................Sq. Ft. <br />..................................................................................4..................._ r........... <br />Order Received._..................................:.........•..........::.. = : ............ <br />V,'ork Completed....................................................................................... <br />Foreman <br />