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�.' j j j: • <br />�Q�G <br />w, o. rort� <br />� � CITY OF EVERE�'I'--Water :Je��c:• <br />Application No.:��� �:.. �._.. :Date..........._�!:.::�._ .:::::........:...19.:.,:�. <br />Install......_ ...................... .inch water serv ice pipe <br />,/ . ... <br />. .�[. �..'/-:.i.`...1.:� .............................................. . . .. <br />For ................... <br />.............�... � <br />'i ..........�. `..�:...�..<.� ..:::..........................._ . <br />....... Street <br />On ........y..::s........ <br />Lot .............................................................. Block o............... _. <br />................. <br />A�l�lilion ......................................................................................................... <br />Remsrks ......C.l.::�'.:.z::�,. /::....::.. ........................... <br />...................................... <br />Superintendent <br />LABOR AND MATERIAL U9tiD <br />--�� <br />_ ,_ .._,....I Lead Connecticn Complete <br />..... ........i Saddle C1omPlel� <br />. ............... <br />............................ ..........................Pipc <br />,..__..,_„ Service Cock <br />...............I Ser'oice 33ox <br />............................... - - <br />No. Hours L� or ............... ........................Sq.Ft. <br />Cut in ....................Pavement....................X........................ .... �, <br />....................X........................ .................... <br />X........................ ........................ �� <br />.... . _............. �� <br />X... _ ................... <br />........................ <br />....................� otal <br />. .Sq. Ft. <br />.................................. <br />Remarks... <br />............................ ..... .......... <br />.......... <br />Ordc_ Recei��ed ..........................................................................................._� <br />/ <br />. <br />.............F'orem n <br />Nork Completed ...................................................._ ...... <br />