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Application *________-_ <br />Entered----------------------- 19. <br />Book No ------- !t - <br />By <br />Lot No.... ....._.- <br />Block No ...................... <br />Addition ................................. <br />Distance A.......--... Fr— ......... <br />... In. <br />B..........Fr.._ ; . .. ...........in. u <br />' V ' <br />C------------ Ft.........In. to <br />O <br />' D............ Fr. __- . -. .._..._In. o ' <br />E E ; <br />Z I Size of Connection. -_____- <br />Date of Installation -.... i <br />Property <-------- C-------- X........ D-------- > <br />Line ----------- <br />A <br />etoa � cocK <br />Curb <br />Line <br />(A) <br />V <br />Water Main <br />Name of Street______________________ <br />