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SERVICE <br /> �rr�. � /j� Q � CIIY Uf EVk-RF11 OROER NO. <br /> �o. APPLICI�lIUN I UH Wl1IF_N 5[Hvl��.f ���� <br /> o�T �' 9 _ <br /> Fixeo � <br /> ❑ n° w. o. � <br /> �, DEP081T f. �00 / ho. - - - - �- � <br /> /J [` oj' L ._ .?p _'� � <br /> ./f ZD �OOLiy . �-.�V ' �F '- . BLK. _ _. OT ADD_ •• <br /> 9ERVICE �w �ooecu�- , , <br /> ��.�,�(.� ONTRACTOR.- 2�-� — � � <br /> OWNER-_.��I.f!'<'rtJ. �� � . . . <br /> IT FLA � -'-- �-+ -� ' <br /> .,_ �_ _ __ _. __ — _-_ a' �_ <br /> INSTALL—/- - TEREOB--ER�— �l�C�.� rn <br /> 1 N�REBY l�VPLY FOR THE USE OF WATER IN �CCORDANCE WITH E 1 � � <br /> OPOIN�NCES AND POLICIES OF THE Yf�TEP OEPANTMENT NOW E%IS NG _ . _ _ ___ _ C C� I <br /> •�ar+eo: x - . .. m C <br /> OR AS SAME MAY BE HEREAFTER CH�NGEQ. -�- r. <br /> Mhi[RI�L6 �--...- Q � <br /> PIPE ��S I C COPPER .. GA�V. .. STEEL .57�i ,—�—_ Pa�ce �Nouw o � <br /> _-" 1 IN. '�, 4 IN <br /> L� <br /> _ -_ __..__. _. _ _ IN I. I ._'-_�__. <br /> CORPORIITION .. I"� � ��S . ._ ... ._--' <br /> __ C_ <br /> - --- - --- --- > -. <br /> cune cocK oT - --', — r � <br /> - --- ... .-. <br /> SERVICE BOX PLABTIC �� C 1 __ _ . . — - - � " ' - � - �� - � -�v <br /> ._ .______ . _" . � � . I . � 'i <br /> METER VALVE VL�(� tl � � -- -' � O � <br /> METERNo.. /�'R�/ 1 /L�r�G TYPE� ���.P4�I '' I .. '_ __ . ._ _ _ _ ' = r. <br /> METER BOX CONCRET Q,SIIC gMALL LARGE ' -- --' f*i � <br /> � _ _ — . <br /> (��� �I-�- f9e�� - — _ � � <br /> < < <br /> H i 50 '3 � _ - 3 � <br /> � 31 -y `� , -- - _ � <br /> _ _, � <br /> __ Zoo I6� calc�.,,�X �r�^^� s�'��c ' <br /> i - - <br /> _-- ---- - I _I _ i - <br /> " � ON <br /> S ��� {.� Y OFF SUB TOTAL <br /> DATE INSTALLED: �J �] --- � <br /> Houns n�T[ <br /> COOE L�lOR ANO EOUIPMENfNENTAL � <br /> — 5,A T ' zH -- <br /> � � '(�/UIQOre: y l� � <br /> _. _...-- �.{- . _ — - <br /> - i . . ._ . . +K i��I ' � ll <br /> ___._ _ __. _ _ <br /> - ___ <br /> � �a6 � y �� �z � „ <br /> _ .�� -- <br /> - �t 3 s��! � ,, <br /> --_ � <br /> -------- I -- -- -- <br /> TOTAL <br /> � f�EM1�aRK4: _�i <br /> � � �• <br />