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�Form fto. la. <br />.�::s <br />' r. <br />� D I`5 Appllrntlnn N . � <br />�... �.�. <br />�GG — G,� q , <br />Nn.... ....- � ................... .'. ... V t....// .......3treet. <br />� . . . . . . . .. . � • //, c��-- <br />F.t•erett..........�- �/J4C� !. �!. :...........190.� <br />.. /....... <br />TO TNE SUPERINTF.NDF.NT OF THE F.PF.RETT WATER CO\1PANS: � , <br />/ / <br />;`;� �� I��e�q nnP1Y for th� uec ot a�nter In nccordance �rlth the rules enil rcFulntlo nt the F.�.-erett Nr.ter Compnn}•, nnd reqi�ent' <br />5 <br />t�at a.�_..... Inch tnp he inaerted In the mafn at the plece nbot•e stnted. : <br />� <br />The F�lumbcr who will do mY work Ix . ..... ... .............. ..... ................................ ............. � <br />L .-�/ �/'�� , <br />The awner ot -[he premisex Is... ,..... �"� � <br />rn.n..... . ... ........ ................ .................................... .. <br />The n8ent le .................... . � ^' ✓� �// ,(,C'. <br />� . <br />.. ... . ...... ... .... .. ................................ ............. <br />� <br />T8etenant Ix ..................... ..... ... .......................... ................................ ............. <br />� �r �t� <br />� The wxter rcnt nhnnld Lc chnrReA to........... ...................... .... ..............................n....... <br />• ........Sisned ................ d�� :r� — ............. <br />(9ee Othcr 9ide). `��..�A Pilcant. <br />