|
�,i w'y' :i'n� � t3rr y-': ' � /�
<br />1� �xk?,��., ir �� � ' . ♦ � . i„, `I" � ��r ,n,c'.CI_.a t .�.
<br />� C t�
<br />f TA .}; .. . .. .. ' �.
<br />� C ~ � C� {+,-..
<br />.3C���_. '` � \ 1 l' � �j;.��� �
<br />_ _� �.�_�, :, � . 2�
<br />� �. App ica � � � ';, �
<br />- , �, ��., roi� :
<br />� :l , . , , - � � /.zS - 1gg�
<br />I _ • �ntcred .... �, ---�• -�c
<br />]JI�I'I��. � �w
<br />..., y�l� �' t , .':l�(� .p� .. . 'Z/� �%8 . �.'i4. � ..
<br />Book No. ...... ..........._.:... . � . . ,-i„i' �
<br />.
<br />,
<br />, � ° /� G P
<br />. i
<br />,.
<br />. By ......................:.^�.... :. .
<br />...
<br />............. _;........... ;...............
<br />„- . • ..I
<br />, . - . ,:: ,
<br />c ,
<br />� � I.ot No ... ...........:.......:..... I . .o i;i,f J �,
<br />' IIlock tio. ........ .� ...................... ,. h"it '
<br />Addition �..... � . ........_.......
<br />Dlntnnca A._. .... .:.'_...Tt .......................In.�.
<br />�� R ....................Rt.......................In.
<br />�� C .............'......Rt.......................ln.
<br />° �� ll_.... ........_I�'L..._ ..................In.
<br />Siz� of'Conncetion.�._ ...........:.....::.....�...:.....
<br />Dnte of Instnlintion .....................................
<br />- ",n:,...�.
<br />� . � i:.� 1 "+ r .� i� . . ,
<br />. . . �. . �' � .. �
<br /><� �
<br />� ...........C.......:�..} A ....., D _,... _>
<br />: .:�
<br />,,
<br />�
<br />•.. r.
<br />c:
<br />i
<br />�
<br />arorn cocn
<br />_ ,
<br />(A1
<br />I
<br />;
<br />Y _
<br />u , :
<br />« ,
<br />N .._ "�
<br />° ' '.2Y
<br />U
<br />E
<br />',eL
<br />.. . . . .:� . .
<br />ILmc .., . . _`..
<br />_ . :i�.:.:..,.�. ..
<br />Line,. �.� ..
<br />�:
<br />�,�� � �._ .
<br />. } �'. aR r�.r
<br />i ; ..•�`;_�:_ .
<br />Waier �
<br />; .� ,; �,
<br />� ..... r� �a
<br />'. Name of Street..... .................... >',
<br />,,- . , i,n �>;w,j
<br />�'t�L iwJx�':: � .,..i..r f ' . ' 1,�'�' .. � . .
<br />� � • . . � � .t.... , �. ... ....,�
<br />
|