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� �� �� <br />w. o. ronH a <br />� - CITY �JF FVERE�I'--Water <br />/..' .?�-% <br />Depr. <br />Applicatiun No..l..t..�/ �.;L. Date..........._�....�.._/... <br />1 .....................19.. �; � 1 <br />„ In¢tall .:..............�............inch water service pipe <br />, / " ..•. ;: i. <br />._, <br />For.......L..�:..:........�:.�.:_:..�.::<.�.......c ......................................._............... <br />J –� _ <br />_.._. _ _.- <br />On ...—..`�.::.:',` :.......... ..:�:.'.-`::..�.....':::.:':......"C`::�'__�.:.::.:....... Street <br />Lo�....�.�.(.F�.......1I.2.....t.Li- s:.......... Block No..._ ................................ <br />.'ldilition .................. ..................................................................................... <br />Remarks................................................................�........................................ <br />,, <br />/ �. t_i' . J.•. <br />............................... ...._..............L..�.�...l.v...............c....-:.w:........................ . . . . <br />...................................... <br />Superintendent <br />LABOR AND MATERIAL USED <br />No. ' Size I <br />- -- <br />............................................ Lead Connection Complete <br />............................................. Saddlc Complcle <br />.............ft............................ ................................................... <br />................. _......................... Scrvice Cock <br />......................._................... Servicc Box <br />:::::::::::- �::::: :: ::1:: :::[ff::::::� ::::[:::f �: <br />Nu. F�Iow�s L�bor ..............................................Cost.................................................... <br />Cutin..........._._....Faacment ....................X........................ ........................S4.Rt. <br />....................X........................ �� <br />........................ <br />....................X........................ �� <br />........................ <br />v �� <br />Total .......................Sq. Ft. <br />=------------ <br />Remarks ............................................................................................................. <br />........................................................................................................................ ' <br />Order!2ecciced ...................._... ................................................................._. <br />lVorkCampleCed ......................._._......................._._.._............._................ <br />Foreman <br />