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Form ho. li. �- � � <br /> 1 ' � ^ > <br /> � � o � .���u�,��ion/��...�?.?!.�. <br /> � N�,... .."7?,......... Z��lV.y�!:�.:��� <br /> "' A` �j Vect. <br /> ... .. <br /> ' ... .. <br /> ' �l'O THP 3ItPF.RINTIsVDF.ICT OF THF, �y1'F.RETT l�'.1TIiR CO\IPAN}•; Rccrc�t,... P.�:.................. 100.Z <br /> !h.... <br /> i hereby nPP1S far thn uxe ot wnter In necordance n•Ith thr ruli�= spd regulnUnnn nf the Gcerelt\Vnter Campnn}•,nnil re��iest <br /> . <br /> thqt,n...��ncL Inp br In3crteJ Iti thc n�aln nt thc p�per ;ibnc� rtatrJ. <br /> Tl�e� Dlumber u•ho rclli dn my w•nrk is....... . <br /> . .... .... -Z <br /> � / � ........... ................................ .... <br /> ... ....... <br /> The own�r of the p:emisen Is...v�.rG: /�} � ••••....,� <br /> .. . .... . <br /> N.�.�............. . .�................................ .......�/� <br /> The eRentfa............................. .......... �� . <br /> .......................... V ... <br /> .................................... . <br /> Thc tenant IF............ ••�� �....... <br /> , ................ ........ ................. <br /> .. ....... <br /> ,The a�ntrr rent shnuld be chrtr6ed to............ . .................................... . <br /> • ............. <br /> ...........'............. <br /> ...... ........1... <br /> ...................... <br /> � Signed. ,/ /�/� <br /> /9rc Ot6cr 3IdeL � E r11rz:V.,4'�->.....�.�.;.v..P.,c"t-.S.t:44;;L-CJ... . ........ <br /> � ../........... <br /> � ��nn�Icnnr., <br /> / A] ' <br /> 7(�1 <br />