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AP��" ��(,, �2 D CITY OF E'JERETT SEN�'IGE <br />No. [ - ORDtR NO. <br />APC�ICATION FOR WATER SERVICE �, ` �1 <br />DAT�G�y�f_..�l. _ ..1Bi} 5/ <br />� FIXED �r �� <br />� � W. O. <br />r� DEPO8IT;.��... No..'__ _ 7',�'' '-_ --/--- <br />' - .. ._ ' _ ,• 1.` ['' ��Lf Yv/L I <br />3ERVICE ur�oo�Uu�_�.� ^' ../ .7 `"' ��=" f __.BLK. __ -.-LOT��_-_A6U__ .. <br />_ __ <br />T"_' __ <br />/ � .a�' � <br />OWNER-_ � . L��� ���. � . ...?i+- . CONTRACTOR ._._ ..___.___--._-___ _- <br />INBTAL 3 �-, -�/ ERED £ERVICE-� . . . . _ _ -___ _ _. .____ __ ���---///��'-----��-��'���I -/. �_.-.-)_- <br />I HEREBY APPLY FOR iHE IlSE OF WATER IN ACCORD�NCE WI1H THE �/� �� ('�i �j <br />oRDINANCES AND POLICIES Oi THE WATEN bEP�fliMENT NOW EdISTING .�aHE4: X -���� -f ���-yr <br />OR AS S�ME MAY BE HEflEAFTER CMANGED. { --"�" - <br />M�TERI�LB W IN. 1 IN. i P IN. I I PRIC[ AMOUNT <br />PIPE COPPER -- GALV... STEEL _ i -' I-_-_II __ . . <br />-------- -- �I ---I .. _ ___. <br />- -- <br />CORPORATION . . _ _ __ _-. _ <br />_ _. . - . ._ ___ _ - ____—___ — _.-__ <br />"-_--- -___ . � <br />CURB COCK OT � ' � <br />__. _.. . _-'___ _____.. <br />SERVICE BO% PLASTIC -- C 1 I I _ _ ___. <br />__-_.- _. . ... ._ _._ __ _ <br />METER VALVE j _. _--- I� - - � � - <br />__._.._______. _ <br />METEIe No. TVPE; I `� ''I _- '. <br />METER BO% GOVCRETE � SMALL LPRGE �� __ _ <br />-.- ______'-____.. _. . . . _ __-_� ' - � . <br />_ -' _ _ <br />__.._ <br />_'_—___-'. . . . . _. — .. -_ <br />__ . .. _-_I __' —' <br />UATEINSTALLED: <br />CCO[ � <br />REMARKG: <br />z z," <br />I t�( UN <br />✓ � oFr <br />I � <br />LI1B011 �HO EOUIPMEN f PENTAL <br />� y3I/a/ <br />' <br />__I_ <br />I I <br />--I---.i-. ..---�I---- . ._ <br />SUB TOTAL <br />IIOUH9 R�TE <br />_S. "TP�c i�t�e. <br />k , ruoo,-e � „ <br />�#z�ri � ,, <br />0 <br />y '. <br />� <br />r <br />� <br />C � <br />r� �. <br />� <br />� <br />c; <br />- <br />� - <br />f�� <br />C � <br />T <br />rF <br />�' <br />:i <br />r�• <br />� <br />O � <br />M1 N <br />V <br />2 (' <br />-i r <br />m <br />r <br />T' <br />]' <br />T <br />f <br />� <br />� <br />� <br />�. <br />