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8279 <br />Application ....Q.e4r.../..�...... <br />Entered ... .... .... ... _:i <br />Book No. <br />..............................�.. <br />Black Na <br />.. <br />.. <br />Aeditiov <br />Distance A. <br />....... <br />Ft. ...... In. <br />u <br />�. <br />m <br />0 <br />It. .....C.......... in. <br />� <br />� <br />Size of Connection. ... <br />._....... ... dr................ <br />Date of Installation <br />...... <br />Property! <br />G_.__.....0............... <br />C......... <br />_. ...D.............; <br />Line <br />.. <br />Cure - <br />Water <br />—_ A <br />r <br />u <br />F: <br />eror•n coca <br />Line <br />IAt <br />V <br />Main <br />Name of Street ........... .. ........ <br />