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Application No., <br />4:nIered <br />.Book No. <br />By <br />Lot No ...... el4lz .... . <br />Block N . ........ ............. <br />Addition................................... <br />.. .............. <br />............... .. <br />Distance A <br />Ft ...........................In. <br />49 <br />B..... . <br />........ <br />. ... . .... .... In. <br />C.. <br />R <br />An. <br />......................... <br />mD <br />......... .......... ......... <br />Ff .................... <br />. ... in. <br />z <br />Size of Connection 'i ........ <br />.................. <br />. 4 <br />Date of Installation ....... ......................... <br />Property< <br />i <br />..... ........ c ..... ........... x .................. <br />D ...... .... > <br />Line <br />I <br />curd — Line <br />R) <br />Water Main <br />Name of Street .......... <br />7 <br />