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/ <br /> . <br /> f�.nn IR:b\\'.I1.�".UY11`dl.�l -rtl <br /> APP(.1CATION FOR VVATEF. <br /> All blankx must he fillyd in or crossed oui. <br /> _ _. .. __.._—.__ <br /> ItLrk\�'!`�_.. Lol./�.� . :\dd............ :\p� icnlion V�� / � / <br /> � � <br /> / � / <br /> �T�.�.... . .................Ntrre� 4:crm�1. 170�L- <br /> . . . .� ........... <br /> 'f:� '1'IIF. SI'1'P:ItI\'I'ISSUI{\'I' III� 9'lll: l:\'F.RIi'P'P �' ;12 CU\IPASY: <br /> j � �hy nppl�� for Ihr u=r n( �e:drr in nr;nrdnum �citL Ihr ni!ra nnd rrg' <br /> uln4„u� nf ILc P:crrrt.l. \1':drr C�mq�nny. fur ILP �IIII'��OvfS IOtlI IISIIII'Pi elnlod <br /> �I�•��16 <br /> Uurinp Ihr limr llm6 nnp nf lhr l'ompnn)'a mnine nmc Lc Inkrn np hy rru� <br /> con of nup imprurrwrnln nulLnrizrd hc thr l'ilc of I:crrrtA. in or ��f mq� FLrrrt <br /> ur nllr�� in n'Lirh Ihr�'nuq' Imcr Lrrn Ini�l. Ihr l'owpnnc �cill naL Lc r^qnirod lu <br /> furni.h �c�drr Jurinp pm�;rr�+ut .nrh np�nc�mrnl; in n/u�• „nnsmnrr ��in�ac eup� <br /> pl)� m:p' ILuc br ruL olf. or Lr IinLl �UI N!/�•H�ndm'c en lo dn. <br /> 'I'hc �rnrK In b�• rcrr�drd Lp.... ................................. I'lum'�rr. . <br /> .i„i�..�.�.��r �:�y. . <br /> . ..'I'ap lo Lr in+rrlyd in Ihr mniu. <br /> .. .....AA':U�r rlace�. <br /> ........Anlh. <br /> ........1'rimu. <br /> ........Plnin fmuyt in+idr. <br /> ........�idr�vnik ��'n=Imr. <br /> • ........Ilo.ie LiL oul=idr. <br /> ........Ilo.r bil� fm' hnildinc pnrposrc, <br /> ........Ilmr LiL iu=idr. <br /> .......Jti6 for alaM1lr rnnlaininp.......lnll...... <br /> ........�IIIII�N'1• 'N`I'fplH in (nmilc. <br /> ........\nmLrr nf �onmJ.�iu Lnil��' �,�//. �,}j' <br /> 'PLr prrmi•r.nrr In L�•n=rJ a�rr.���J/������%�.. .... ..... ....... <br /> '1'hr ua'nrr a! ILr �i, ini�r+ i��.�.. G. .. ...... ....... <br /> i <br /> 'ILr n��rn�. i- .......... . . :...� � ....: . .. ..�..... . ..... <br /> / r <br /> Fipnrd......::..(.... �, ��/y�: . . : ... . ..\pph�:ml.. <br /> �?or o�hrr ,idv.) .....0 �_��� � � � <br /> � <br /> / <br />