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APPL. �� SERVICE <br /> No. CITY OF RAT ES ORDER <br /> APPLICATION FOR WATER SERVICE No 5962 <br /> 1C� FIXED DATEC�L_ 10. <br /> E C� <br /> DEPOSITS _�-O (� / /� /, ' NO. DSp\ <br /> SERVICE ler AooR[�__ �L'AJ•� �� – 1� (Lµ� � �-`� - BLK.. LO`L�ka�� <br /> OWNER C c ul l✓U iwA S CONTRACTOR <br /> INSTAL II AT <br /> VICE CDo& C <br /> I HEREBY APPLY FOR THE USE OF WATER IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING <br /> OR AS SAME MAY BE HEREAFTER CHANGED. SIGNED:X -- <br /> MAT[RIALB A IN.I 1 IN. I E IN. I PRICE AMOUNT <br /> PIPE_ _ COPPER••GALV.–STEEL <br /> CORPORATION <br /> CURB COCK OT I _ <br /> SERVICE BOX PLASTIC -- C 1 I <br /> METER VALVE <br /> METER No.-.fy �_ TYPE:gepftx — <br /> METER BOX CONCRETE SMALL LARGE <br /> I <br /> I <br /> DATE INSTALLED: //// {, I OFF SUB TOTAL <br /> CODE LABOR AND EQUIPMENT RENTAL HOURS RATE <br /> -- – ------ TOTAL <br /> REMARKS: <br />