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�`'P�-• '�� / � AFPCICI�FION FOR SERVICE SERVICE;�_ 132 <br />No. (� <br />ORDE / <br />�'�,�;p CI �F EVERE'fT W�ATER DEPT. //� <br />� FIXEp �%L � � �Z"C�„"`-�-_'1C / `�' DAT �i� � '�19'� _ <br />� DEPOSIT 5 fl�� ` W. O. / <br />No. <br />SERVICE (eY qoDREss)_ ��« ,� O�y �� • BLf:._ L O T.___ R U D._ <br />WN�E�� CONTRACTOR <br />�u""� .J/// � FLAT �— — -- — <br />INS'FAL�_L� _%M�'D SERVICE__ _____ <br />I HERE9Y APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE � ��,, <br />ORDINANCES AND POLICIES OF THE WATER OEPARTMEN7 NOW EXIS7ING ���4� ,�'/� �.Y_d�� <br />OR AS SAME MAY BE HEREAFTER CHANGED. SIGNEo: X __ � �___� ___ <br />R�AT[RIAL9 ?i IH. 1 IN. � 2 IN. � I PRICC A tOUNT <br />PIPE _ �OPFER -- GALV. -- STEEL � � �I � I I—^I �� � �? <br />CORPORATION <br />�"^---�-------- <br />URB COCK 07'% <br />SEkVICE BOX PLF <br />METER VALVE <br />METER No. <br />METER BOX CONCRETE <br />DAT[ INSTALLED: <br />CpOE <br />--�' _ � ���- <br />CI <br />TYPE: I ;Z <br />SMPLL LAP.GE <br />� _ � � ON <br />/ �_�.�•J <br />/" � ��' `� � OFF <br />LABOH AND EOUIPME�TR[NTAL <br />-,t <br />r �_ <br />� , __ _ -- <br />; <br />SUB TOTAL <br />HOURS I RATE <br />J <br />Z �i <br />��� TOTAL II ✓ �'I�/"�f <br />�� 1--� � �_ �-. <br />� . -. , <br />