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,.. i,. i'. i�:� 4 I500 J-I-17 C. P. <br />G17'Y OF i:i'CRETT==Water Departmei�t <br />�p��laeation for Watea- <br />:111 bl;mks mus[ bc fillcJ in nr cr��s=cd out <br />F,ccii�tL. ' " _"_. _'�/l_�____ .195" ( <br />"i��� 'i 111? tiU19CK11�1'IiSUI{V'f OP "PlIH \VA"1'ER U8PAR7'R1tiT:7', <br />C.I'f�' 01� I `/I3ItGPT: <br />1 herehy aPPly (or the use of �rater in :iccor�ancr o�ith tl�e rulr.:md ref:��la- <br />tl �n; uf The Natcr Depnrtmea[. fnr p�.irpnsec ;r�d fixtw'es sta�ed hclrnc. <br />Durinti the time dia[ nnp ui the watcr mains may be taken up by rrason ut <br />:my impruvements authoria.ed by Inc Cip� ui livcrut[. in ar o( anp s-Vicet ur aliry in <br />�r:iich tl•ey mav have 6een laid, thr Citp will „nt be required tu (urnish nater durin;: <br />�he pru�-ess n( such imprnvrmenls tu uny ennsumer wha=e su, ply may Ihus- br � ut <br />�di. ��r b�• li,iblc for an}' dantaS�� pf��r its Gilw'c so tn do. <br />'.ppliurtinn I�u.'___"7�_ /.�__"' <br />C� � <br />Blurk _.J_•fL O_ . ___Lnt_.%l— '� _'_Add . _. . . _ <br />.._ _.._ _. __ <br />Vo.__"_"_�.--/-�6 __ ""��..r---��___Strrel <br />. .. ___' ......... . ....."_"'"'__,_ '� ......_. _..___'.__.__' <br />""'"_"_"'_'_. <br />�' . (__ <br />'I�h�� �cork to he executed b}' -"_" :/`" '.�__-_ .__ .... . __ Pluntber <br />tiCitc sizc n( tap. <br />./'�_. •__ Pnp tu Uc insencd in the main. <br />. _ _ �. _ _ _ 1A'ater close[ <br />_ .1__ ..Ifatli <br />_ . . . Urinal <br />_ _..._Plain (aucctinside <br />_ _ ___.Side �call< washcr <br />. _""Ifnsel>ibuu�sidc <br />___' _. Hose bib (or huildin1: purpnses <br />� "-- /� � � <br />' ,� � �`, <br />i .-'p.. <br />__ __'__Hosc bib insidc " - . <br />_'__.__Rib(arstablecnntainiug-.__..__.stall___"_.__' . <br />.. ____Numbcro(prrsonsinfamil}• <br />e�-; ___Number u( roams in 6uilding <br />"fh,�premise:aretubeusedasa_.._._._.. ___.._._.._ . ..... .. ...... <br />l�iir mcnerofthepremi;esis __'_'_____'_'.'_._..__..._"_. <br />'I�hrallentis '_"""'._"._...'__'.__'_'_. . . <br />l'Li: :�.pplication. although sigr.cd. shall not be binding up�� the Cij}�, until ao <br />vpted bc "Chu Si�perintenLe�i[ u(-t}�c \Vater�Uc ' r[m2nt. ``♦ <br />i \ <br />SiFned..."_i:�-..."'. ..__ .;�_""'�r __"__"_'App�ican[ <br />.�u'rp�ed.�.'%_ ��1. ��� / Ity=� _�j.l .. . . _ ,,...i..._.__ <br />/J <br />