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C Y/ 7 2 ✓ v/ <br />W.0 Form] ?i y ji...� �"/ C ✓ nJ <br />CITY OF EVEREI7I Water Dept. <br />Application No.. AZI.y..Date. _........t: <br />. ..................... <br />Install ................................inch water service pipe <br />For.............//.................g...............-•- rf� <br />..•.-.7............................. <br />On ................-•................... ._.... <br />Street <br />BlockNo ........ ....... _.................. <br />Addition <br />Remarks <br />6' Superintendent <br />LABOR AND MATERIAL USED, <br />No. I Size i <br />Lead Connection Complete <br />Saddle Complete <br />Service Cock <br />Service Box <br />No. Hours Labor........................................... ... cost ............... ....... - ... ....................... <br />Cutin .................... Pavement .................... X.............. - .... .. ..................... Sq. Ft. <br />.................... ........... ........... <br />...................�X----- <br />M <br />---------.... -......................... ........................ <br />Tntnl 0- V. <br />