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LOT . .......... <br />BLOCK... ... <br />NUMBER.... ............. <br />ADDITION ............ <br />Distance A .......... Fr ............ IN <br />B .... ... Yr ............ IN <br />C .. .... FT ............ IN <br />D- .... .. Fr ...........IN <br />Size of Connection........:_....... <br />Date of Connection ....... :..c... <br />No. Hours of Labor ........ - ...... <br />Building I <br />Line <br />A <br />STOP COCK <br />STREET............................................................ CURB <br />. . ................ ................... . ...........................STREET <br />WATER MAIN <br />..............In. Lead Connection Comp......................... <br />..............In. Saddle Comp............................................. <br />Galv. Pipe....— .................. <br />