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/ � r J - <br />.:. D. Fonn 4 ISCG 3-I-11 C. i'. <br />Cli�' UF [:VCRCT'I'==Water Deparlment <br />�,�g�flicati�xa �'a� W� ��° <br />:AII hlanks must br�li yYl in or crussed aii�� <br />1 i <br />liverelt. _"_'__"�'� // -.._._._.191.�(_. <br />-1-=--- <br />rn rrn: sui�i:r,i� re�u�:n r cm �rri� �vt�•rriz nei�,�aT��r:h�r. <br />crrv or• e��r:a�:•r�': <br />I herehp �iPPly ior tl�e use uf �ca[er in accurdance �cith the rules and re!:ul,i� <br />tlo�i. ��[ l'he Nzter Dep�rtm �ui. (or Purposes and lixu�res- stateel below. <br />Uurin� tlic time �hat anc nt the �catcr m:�ins may be t;d<en up by rcawn uf <br />:ml' imprnvements' authorized by the City uF Gverrtt. in ur n( anc strect ur alle7' in <br />�chich thcy uril' havc bren laid, thc Citc trill not 6c required Iu furnisii a•.itcr durim: <br />tf10 �1Y�1C(C55 11( Sticll i1nllNVCIpP�1�5 lO :Illf L'OpG11111C1' NIIUgC •tI�1E.IC �IIAV' tllu5 i)o c'.:t <br />,�iC ur be 1i:�61c (or :my d�umiqcs fnr ite Liilivc su lu do. <br />` �� ,/ <br />.\pplicntionNo.'__�-.-_ _ _�___. <br />-" _ _ <br />Itlock . _ `_'�._,1-�' Lut__'__ _'-._-__--_' �Jd . . . � <br />�� - .�__� - �. <br />\n. _._� �/ �-' ---- /�---�------.. ---- .. Sircat <br />_ _"" <br />__'_""' . '____'"_"_'__"_'_"'_"_'_'___' <br />'fhc wurk to be cxecule[I bY' _"'__ - ._ Plumhc� <br />St:rtu c � u( f:1p. � <br />�ti <br />.���_"fap to bc inscrlcd in the m:�in. <br />/ /l' / c.� C' <br />. _R�atar cla��C , y� <br />. ..% ...13ath -._.l /:J . _ <br />. .Urinal i vE t:'.'.:: <br />Piain faumt insidc l= . -�"`e= ,-. <br />i,. w �1 �� Ii� <br />-. __ Sidc �c:ilk wasLer �_� /// A,, � I . <br />Hose bib outside � .� � � � � �� ��; <br />� <br />. _ llo,e bib (or buiidine P�vpn<es �� ,/j���_ �. .. <br />�„h � <br />..._..Hoscbibinside �� (\ <br />� <br />Uibforslablecmit..inin{t.-._-._- _.sLill.. ���r . <br />____ ___NumhcrufPersonsinfamily �� � ,{��, <br />_...__ ��� h��.� <br />. __Number of romm� in buildinµ s���% <br />'Chep�entiSes'a�'r[ubeusedasn ..... .................."___"""__ __... <br />'I'henwneru(IhePremisesis ____..._______ _ __ ________________"_._.. <br />7'hc:iRvnt i5 ___" "_'_"_.'___ .. ...'_'_-______'_"_'_'___'_.... <br />7'his applicatimi. ai!hon�:h s�g��ed, shall nul bc biuding upnn [hc Ci[y, until ac <br />:��ptcd by'1'hr Superintende��t of u. rter D^_parunent. <br />SiFned.__.,__ ___t_._(.'�.D��!�Jl,l�".�.}—'_.__.____ PPlir�nt <br />�t .- <br />.',r:�yne�f� � _ 1 i - h•: _ . . _ . . _ . <br />