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�1' <br />Y!. O. FORM ] ���'" /� Acct. No....... ��.% ' f••••.• <br />' ClTY OF �VEREiTT—Watcr Dept. <br />�, . � � ' —./:._<_'.1..:..is........ <br />Applicatior_ No.l.,..._�.......�...... Date......._ .............�_<..... <br />Install ................................ inch water service pipe <br />.... •---......-- �y ^ , . <br />Add:ess.._-..�`.�//..._ ....../...7..-._._L-L!:`:v-- . .................................... <br />r,.. _ -- ................. Block No......_.........._........_.-.. ........... <br />Addit io n ............. <br />Contractor.....: ,-. <br />....... Rec. No ...........................................�---�---.............. ._. <br />� n �i' <br />� _'. ,i �c..Z, Z,.� _ �, y...,1�.. <br />IIy .............�....:. ..............--�---(..j .._ �.;:ff <br />Superin en enf" <br />Shop Remarks....... <br />..... _ ..................... _ <br />-- .................................__ ..............................-.. .... -....... <br />_j <br />Work Completed _....._._ ......................_ _ .....Foreman ' <br />� <br />