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'���0 / ,,:`�,� <br />W. D. ! NIA w <br />� CITY OF EVERE d:I'--Water Dept. <br />App]ication No.%_„._''.'�. !:.. Date ............... :5..'....L....................19..� % <br />� 7n:tal,l ......................._....inch water service pipe <br />. � .�1 �.�.: <br />For ... �....__...� .... ............................................................ <br />�--���.-� �g;�. <br />on _ .....:.,t,�_.._ ,; , <br />...._,.� ......................_�:_::.:...:.'. ::. ._... Street <br />. . .. ................................... <br />�. ��' -• : <br />Lot._ �: ..�..:' / 1•` ,• ..... Block No.........._........_ ............... <br />................................... <br />::ddition ......__ .............- - - -- _ <br />Remarks................................... . . . .. . . <br />/J"% . ... . <br />......................................./........_�-...1/./....t..:.! r.2:.�.(,::l.t::.... .........................---'•- <br />_ ......... ...... ....:............ .........................." ..._................. . . .... .. ... ....... ... .... """.. <br />�''�� {�/��'� . .... .......... ..... <br />......... ...................................................... <br />� ___ � �/" J = Superintendent <br />/ <br />LAROR AI�D 11fATER1AL USED <br />No. 'i Size I <br />...........................!..........._....:....._..I Lead Connection Complele <br />........_ .................I...........................� :da:ldlc Complcic <br />................. ........................................................................Pipc <br />................ Service Cock <br />................. Servicc Box <br />No. Hom•s L�bor._........_............_..._ ..............Cost...._........................................_.... <br />/ ....Pavemcnt ....................X........................ ........................Sq. Ft. <br />/r f. % ul � ...............� ( /, : <br />� ,. <br />� } ...................X........................ ,� <br />........................ <br />,- � _ _, ; <br />....................X........................ ........................ �� <br />... � . / <br />!;'. .._'�'.i . � � ....................X........................ i� <br />: . . ........................ <br />/ � � � 1'otal <br />............... ........Sq. Fl. <br />---------- ------ <br />P.emarks ............................................................................................................. <br />................................... ...................................................................................... <br />Order Receiced__ ......................................................................... <br />.................. <br />\Vor'r. Completed ..................................................................................._..__. <br />Forem�n <br />