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iiln!1�1"71 �n'rPtl1]11111R8�d1�9i73'Yei�a`�Fi!<i��1Al1R?.111'NN�6 fy <br /> CITY OF EVEREM-Water Dept. <br /> 9xe (I L , <br /> — i <br /> Application No.... Date....... :............_............. <br /> 19»�•.� <br /> lnstalL..........................-..inch water service pipe <br /> For ......./............._.............._.... ........................................................... <br /> 46.5;.f. <br /> ..................... ................ <br /> On ..... ................... ....... .............................._...._ ._......_.._... Street <br /> Lot.............................._.......................... Block No................................ <br /> Addition .......................................................................................................... <br /> Remarks ..................................._........................................._................ <br /> .........................................................................................._........................ _ <br /> 4..........G� <br /> .... n.................._.................._....._.........................._.........._.._.. <br /> ��-... .9... ..7. <br /> ..................................................................................... <br /> Superintendent <br /> LABOR AND MATERIAL USED <br /> No. Size <br /> ...............................»................. Lead Connection Complete <br /> ......_.._.......»._............................. Saddle Complete <br /> ..........»_....»..SL_._.................... ..............................._.._.............................._...Pipe <br /> .._.........._...................................». Service Cock <br /> ..............................................»..._ Servi:e Box <br /> No. Hours Labor..................._......_..............Cost.._......................................... <br /> Cutin....................Pavement..............._..X........_........... .....................Sq.Ft. <br /> ....................X........_..._._.. " <br /> ....................X..............._.... .r <br /> ....................X........................ .r <br /> Total ........................Sq.Fl. <br /> Remarks...... . ......................................................_._................ ........... <br /> ..... <br /> .......... .. . .... .................. ............. ............................... ....... <br /> OrderReceived........................................................................................... <br /> WorkCompleted............................................................................................ <br /> Foreman <br />