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s �.P�,_o..M��z3 33 - � —. <br />lV. D. Form � <br />CITY OF EVLRE'1�'T--Water Dept. <br />,; , <br />Application No._--� -..: .d:-�: �Date.:._:.r:.r.:.._--.::..--.-"=-.:.-----....19--`:.- <br />� ,.�._... <br />Iustall._....:�' :..................inch water service pipe <br />For..............................................._..................... .................._............. <br />' � ;' % ,-� /� � r1 '7'; :. <br />Ou.........._L........_...........�---......C...il.`y ...................................._....--. Sireet <br />T.�t _ - - -- ............. Block No.........-----...----.............. <br />Addition ..................:.:�.....i. <br />I�'; .. <br />Remarks ..............::..:::.....: <br />......................................................`.,...._....: � �......................................... <br />; ii <br />.....:............................................:.......:...:.............._- .......................... --- <br />� <br />`� .... �. � _ <br />� , r <br />....................................................... ' ...-----.....:.:........................... --......_- <br />i , / i ( Superir.iendent <br />LABOR AND 1VfATERIAL USED <br />No. I Size <br />Lcad Connection Complete <br />Sado]e Completc <br />Scrvice Cock <br />Servim Box <br />Nc. Iiours Labor .............................................Cost.................................................... <br />Cutin._..._..._.......Pavement ...................X........................ .......................Sq.FI. <br />:-:lJf /� , F ! JF—" .._ ............ ...X..............._....... ........................ .. <br />, <br />• ..�`1 ............._.....X........................ ........................ .. <br />� � <br />� . •:, a <br />i - i _. .. <br />� :- .. ...................i�.... ................... ....................""' <br />'Potal ........................5q. i��.. <br />Rema <br />Order Receive ..... <br />..............._ ...... <br />Ccork Completed:.. � � <br />:............... <br />...................................... .................... .. <br />.... � ... .................................................. <br />._......_ ........................... �.:............_... % <br />% ' 1 <br />...........__ ............:..:..r: -_.................. <br />Foreman <br />