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Application..Y_ 0------------- <br />Entered------,,,//� � 6 ----•--•--t 1q3 3 <br />Ji/ Book No. --' 30 = 3 <br />BY--------------- /77�--------------- <br />LotNo - - - -------------------------------- <br />Block No --------------------------------- <br />Addition --------------------------------- <br />Distance A.-----.----. Ft- -------------- In. <br />1 .. B.--- .. ..-. Ft. _____--In- <br />-FtC_... _-.-.. .-- --.In. <br />D.....-- Ft. -.-..-. ------ In. <br />Size of Connection, .-.-------- -------- <br />Dnte of Installation ......... ............. <br />Property <-------- C.------- X--- '--. D---- > <br />Curb <br />Water <br />Line ---------- <br />Name of Street --------- --------------------- <br />Line <br />Main <br />