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-7a 5�� <br />CITY OF EW.rRETP—Water Dept. <br />Application No ... 11L.,!�..... Date.............-.1..::.(4.! <br />Install ............................ inch water service pipe <br />Owner..............._............................. _.._......_....._....._. <br />Address .................... <br />/.. s�Q�... _....G.. J`=_..............._. _. „. <br />Lot..................... ................ <br />.. <br />Addition .................. _ ... _..... .............. Block No .................. _.................... <br />....... <br />Contractor ....... .._____ ......... <br />Amt..._.._.._..___.._._._....... Rec. No ..... ........ <br />_._. <br />By....................... ' <br />Supe n tendentIP <br />Shop Remarks ............................... ....... __ <br />WorkCompleted ........ ............................................ <br />Foreman <br />