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N�`�, I f� � qppLICAT�ONOOR WAT�ER SEfib'ICE <br />SERVICE <br />ORDER NO. <br />DATE�/-4=--� 9 �f- <br />�FIXED � yy p. <br />� DEPOSIT ��5�� No._------�-�- <br />��c�� �� �� � _BLK._ LOT� AD�UCIL�Z. _ <br />SEk2VICE (BY ADDIiE6C) _���������— ---- <br />/� /f��-.✓/�_ CONTRACTOR_ �— ------- � <br />OWNER Y� <br />I �c -_� <br />IN57ALL�-- M�.TERED SERVICE—�- ------ <br />IN ACCOPDANCE WI7H THE ���_ <br />I HEIiEBY APPLY FOR TN �'-eF""�'T��� - <br />OitDINANCES dN0 POLICIES OF 7HE WATER DEPARTMENT Nf1W E%ISTING P �HEo: X. - � � <br />OR AS SAME MAY BE HEREAFTER CHANGED. paicE � AMOUNT <br />MATERI LS I IN I 1 IN I 2 ��M � � I�� <br />I ti�r I I � <br />P�PE C�PPER -- GALV. -- STEEL <br />CORPORATION <br />CUR6 COCK OT _ <br />SERYICE BOX PLASTIC -- C I <br />ME7ER VALVE ___.,_ --- �- <br />.S, %r2:� __ TYPE: CfI'P���N I_ "5 <br />METER No. __ --- <br />SMALL� LARGE <br />ME7ER BOX CONCRETE . CR_ _._ <br />--- �_Jl� f�N.�'_ -- <br />---- --- <br />_ � �' O N <br />�ATE INSTALLED: 7- ��'- 7 7 f� OFF <br />LAOOR AND EOUIPMENT PENTAL <br />COOE � <br />� -. _ _ __ _ _ _ <br />I � <br />� �� �_'� <br />I_--- _- <br />REMARKS: _ _ _ . <br />SUB TOTAL <br />HOl1R5 � FATE <br />70TAL �I \ � _ <br />