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��� <br /> . ✓ <br /> S :i'�iebeiN�'..i "_r .: � . <br /> W.U.Pora 3 � r' . <br /> T`I OF E ERETT--�'Uater Dept. <br /> ; <br /> Application No......�.............__. Date....._....................................._.19....__ <br /> Install...........'..................inch water seivice pipe <br /> For ................._ ....._.............. ...........................-� ...--- ..................._ ... <br /> . . <br /> On ......._.........' .::...:...::.:....::::.......:...:......:..._ - - .._...................... Street <br /> Lot............................. ��---..................... - Block No..................................... <br /> Addition .................................................................... .............................. <br /> Remarks ................... '-.:........ - .................... -_......... ............_.............. <br /> -- . <br /> .........._.__................ ......................_.........._�.....:,...�.- ..............._-......----- <br /> . .... ..............._.. � ......--' - ...............:...................�..................,._--.........._.... <br /> ...................�...........:�.................................i.:.......;.._................. <br /> \ <br /> ..................__.............._.........:.:.................................. - ........_- --............... <br /> 'Superintendent <br /> LABOR AND D7ATERIAL USED <br /> No. Size <br /> ._..-----I ---_..--- <br /> ........................................_...._......I Lcad Conner�ion Complete ; <br /> ....................................._............._� Saddl.. Cemplete , ; <br /> —ft.. . _......_........--......................................._..........Pipc �� . <br /> .................... ......................... � <br /> ...................................................._ Service Cock � . <br /> __........................ ....................... Service Box '; '. <br /> _................................................., ..........._........ _ .:..... ............................ <br /> . �l _ � - _ ... <br /> � <br /> .................... . , _C � .. ......... ................ <br /> r . <br /> ; ; <br /> _ ................ ...... .:. .. ..._. ...... .. .. <br /> _..._.................. .........:,,,�.....:...:. ....:......................................I... ....................................._......._.... -. <br /> No. Hours Labor..............................................Cost.................................................... <br /> Cutin...__......_.....Pavement....................X........................ ........................Sq.I't. <br /> ....................X........................ �� <br /> —..................... <br /> ......._..._.......7{.........._............ ......................_ �, <br /> ....................X........................ ........................ �, <br /> ibtal ........................Sq.Ft. <br /> ---_-------�--�---- — — — � —_ <br /> i „ � l, t' �i� i <br /> , , � . . �. ' <br /> Remarlcs.__�..:... . � ......... � I <br /> .............1. ........... . :.�.�..................... ...«:,:.. <br /> , , . <br /> f j, <br /> .. � . �.............. � <br /> _.................____............................................... ..............--..... ..j. <br /> .................................................... .................................. . ' �.�........... �-- <br /> OrderRcceived........_.......`..._.................................... .:�'..�.......-- - ......_ <br /> : . : <br /> � -- <br /> �`lor};. Com�leted... ... ..,.�,.,=...�.:...:...L�_,�_>,�................._....... . . . ......_ � <br /> � . � Foreman <br />