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�� 1 � '�� �y . <br /> ff � <br /> r� � �� � � . . . <br /> Applicatlon............................................ <br /> Entered ............................................................19...... <br /> Eo�,c No..................................................................... <br /> By .............................................................................. <br /> ILot No. ..................................................._..... i <br /> 1 ` <br /> Hlock Na. ...................................................... i <br /> ; Addidon ........................................................ 1 <br /> � I � I <br /> � Distance A....................Ft.........................In. � <br /> N i y . <br /> oI i� fl....................T'�.........................TII. p ( <br /> y ; �� C....................F1.........................111. w i <br /> . ' <br /> x ; " D...................Ft................_.._...In. z i <br /> j Size of Conncetlon........................................ ' <br /> '; Date of Inetalladoa................................... � <br /> . � <br /> Property C.............C...............X................D..........._y Line.................. <br /> A <br /> i <br /> � <br /> i <br /> �TO� �COCR <br /> Curb— Line <br /> � <br /> (A) <br /> V <br /> Weter Main <br /> Nnmeof Street...................................................................... <br /> I <br />