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� µoP�,= ��&�"' APPLfC�1TION POR SERVICE <br />', CITY 0� E4'EitETT WATER DEPT. <br />�� FIXED <br />� � DEPOSIT y„2 �{'�U r�% <br />', )� IA �� /( y/� <br />� SERViCE (BY ADDRE581.{LZ�_��C.fL_�—!-�—L="����� BLK.— <br />I� <br />UWNER ������"^'���'� CONTRACTORdL.t: <br />� FL <br />INsTALL�— TEREU.rSERVIGF ---- ---� <br />� - � <br />i I HEREBY APPLY FOR THE USE OF WA7ER IN ACCORDANCE WITH THE / <br />I ORDI�ANCES AND POLICIES OF THE WA7ER DEPARTMENT NOW EXISTING <br />OR AS SAME MAY BE HEREAFTER CHANGED, s�cN[o:X��%�J <br />MATERIAL9 ii IN. f IN. � II N. �� <br />� p�pE IOPPER GALV. -• STEEL �� � <br />�_ -���--- � -�- --- <br />� CORPC�IYATION I <br />�' CURB COCK _ OT _ __�__ _ <br />� SERVICH BOX PLASTIC •• C 1 I <br />—_—___ { I <br />� METER VALVE __ _ . _/__ __J_._.. . <br />— ___ _ _ _ _._.— � �f�L S%l�.. <br />� METER No. ��f�� TYPE:(��j�ti � 35 _ I._ I—.I.— <br />METER BOX COIvCRETE � SMALL) LARGE <br />i-- ___ _ <br />j_--�-l��d-r--- �Jl - <br />� <br />--�—_ _ � ON <br />DATE INSTALLED: //� � �f^ � I � OFF <br />pC / <br />CODE I LABOR AND EOUIPMEN�f RENTI,L <br />� � �'-- -�-� � --- <br />� -- �� _'�f��---- <br />I'— - --- ---- � <br />� � --- ----- � � -- --� V::;L__ — <br />I--j y� <br />I--- -- ----- --- <br />I_— - f /�'cl r i <br />� — <br />I REMARK5: <br />.. _ __ _—__.__ _—_—__- <br />�_.._.._'_—__ —'_—____ <br />SERVICE Ng Z3�$ <br />ORDEF <br />DATE_1L�-1 �L <br />W. U. <br />No. ___—'—_ <br />/� ,�/ � <br />[1L. •y� ADD. �sc' � �.G /6�� <br />zE�,..1wii�-i��—,��� <br />PRICF (I AMOUNT <br />I SUBITOTAL <br />H� URS I RATE <br />I— <br />TOTAL <br />