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App)ication No._( .... {.. ...... <br />,f-LE D <br />Entered '_._�I9Lg�" <br />Book No. f. <br />By _ _ C��� .. T �._:c. r✓........._. <br />I.nt No ........ ..�...44�.. ........ . . <br />Block No........ ..` ..... .................... ... : <br />Addition................................ ................................... .. <br />w Distance A.......T...... Ft ...........................In. <br />on V <br />C................. ........... Ft ........... ............... In. <br />h., D.............. .......... Ft........... ........In. z <br />Sixc of Conncdion....... .......... ............ .._�...r...,.'.. <br />Date of Installation....._ ........................ ��.... Z <br />Property<...............c..................x.................p........._. > Line <br />.... _ ................ . <br />iA <br />m <br />Stop a Cock <br />Line <br />Water Main <br />Name of Street........_... ........... <br />