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S.y/ � 2 1v4 l7/ 3 <br />- CITY OF EV IRE T T--W(( ater Dept. <br />Application No.%.5... ..'rZ Date..............G.l ..1................... 19....�� <br />Ins+a� ..�....%../.. Itch er service pipe <br />For ..(•��...a�><:�.tc.r........ ✓�:f�,tC.,..:'........................_..... <br />On ......... IC.t..R... C..... ....... rF (....- ............. ...... Street <br />Lot........................................................... Block No.................................... <br />Addition................................................................................................_........ <br />Remarks................................. ..................... . <br />......................................................................................_..........................._... <br />...................................................... <br />Superintendent <br />LABOR ANL `.TERIAI. USED <br />Lead Conne, Complete <br />Saddle Comply <br />.............................. ............. <br />...... <br />_....... ..................................... Service Cock <br />....................... ... ..................... ..... Service Box <br />............................ I.-............. ............................................................ ................ <br />OrderReceived..................................................................................... <br />WorkCompleted ....................... ......... ......... ...... _.................................... <br />Forcm n <br />