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Curb --. - <br />Water <br />Application <br />Entered__..._....__.. _.19 <br />Book No. -> <br />By <br />Lot No. <br />Block No. <br />---- <br />Addition ,._ <br />Distance A <br />Ft. ...... <br />In. <br />4 B <br />Ft. <br />....In, <br />C <br />Ft <br />In. <br />D_ <br />Ft. <br />In. <br />Size of Connection <br />Date of Installation <br /><' . , .. C X ... ......... D - 1> <br />Name of Street. <br />A <br />$TOP I X Ica - <br />Line <br />Main <br />