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AP PA2"�,��,y -3 SERVICE...9 CIYY OFEVERETI' ORDER NO. 3771 <br /> NO. <br /> APPLICATION FOR WATER SERVICE <br /> DAT <br /> ❑ <br /> FIXED C <br /> DEPOSITS �Q / N <br /> SERVICE (MY Al •�Iy�/��/, ''�, +—BLK.. LOT —A <br /> OWNER—pols���5� --CONTRACTOR <br /> INSTALL_1LL�METEREO SERVICE <br /> I HEREBY APPLY FOR THE USE OF WATFR IN ACCORDANCE WITH THE <br /> ORDINANCES AND POLICIES OF THE WATER DEPARTMENT NOW EXISTING SIGNED: <br /> OR AS SAME MAY BE HEREAFTER CHANGED. <br /> 'AIN. 1 [ IN. PR [ AMOUNT <br /> MATERIALS <br /> PIPE - COPPER-GALV.»STEEL <br /> CORPORATION _ _ -- <br /> CURB COCK OT <br /> SERVICE BOX PLASTIC - c I <br /> METER VALVE <br /> METER NO. TYPE: _-- <br /> METER BOX CONCRETE _ SMALL LARGE <br /> I <br /> WON ON <br /> DATE INSTALLED, OFF SUB TOTAL <br /> LABOR AHO EOUIPMEw RENTAL 1 HOURS RATE <br /> CDD[ <br /> - <br /> -I <br /> -- I TOTAL <br /> REMARKS: - <br />