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��81 '" � <br />,.. <br />w. o. ro�� <br />� - CITY OF EVE.i��TT--Water Dept. <br />Applir.ation No.L:..'.�_.`t.�� ./._. Date..........t�........l ......................_.19.._!,� ✓' <br />, I�stall...........1 ................. .inch water service pipe <br />� /: - _-. � <br />P•or ........r�.{.1 .....::..:..:.:........�r:e..,..1.:.:/.._........._....................................... <br />� +i:.......���.......: t�c:-i �. �!:.' ................................ Street <br />On - r....._...... <br />.......�.,._.. <br />Lot......:?1J!r7...::..� �.�'--���� � :.................. Block No..................................... <br />A�i�lition ............................................................... <br />............... <br />............... <br />..._.. � ................... <br />i? emarks _ %y,................ <br />................... ................. <br />...................... <br />; <br />�,... .-;�; ..............- <br />................................................... <br />�...: . ........:.:::.r�. _........,....._............ <br />.................................................................................'-'--...._... <br />.......................................................................................... . <br />-- <br />....................................................................................... S�perint:endent <br />— �R AND MATERIAL USED _.�i <br />Lead ConnecLion Complete <br />gndGlc Completc <br />. . ......................... ............................... <br />..........PiPc <br />Scrvice Cock <br />Service Box <br />.............. <br />�� <br />tiu. Hours Labcr.__ .........................................Cost................................................... <br />........................Sq. F[. <br />Cul m.._..._.._......Pavem�nt.._ ................X_...................... �� <br />....................X........................ ........................ <br />....................X........................ ........................ <br />„ <br />....................X........................ <br />........................ �� <br />Total ........................Sq. Ft. <br />= _-.-- <br />Remarks... _ .............................................. _.. ..... ... . <br />_ _......_ ............. <br />................._....... - <br />Order Receiccd._ .................................................... <br />\Vork Completed ......................._._........................._ <br />............................. <br />.............................. <br />...... _......... <br />I'arema <br />