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Li <br />Curb <br />Water <br />Application, ..'_ _ _ _ _ _ - _ _ _�_/ _ <br />Entered ---------_ <br />Book No ------- <br />By------------------- <br />Lot No. <br />Block No._______________ <br />Addition ___________________ <br />Distance A. ----------- Ft ....... ....... In. <br />•� B----- .------ Ft --------------- I, <br />C------------ Ft --------------- In. <br />She of Connection ------- <br />Date of Installation .-..•_______________•-, <br />Propetty I <----- __C-_..---- X-------- D.. _....9 <br />Name of Street-- - - - - -- -- -- ----- <br />Line______..__. <br />Line <br />Main <br />