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�J � �� <br />,r� � � <br />. ra� No ......................�--�-...... <br />t-- ' 1�ZUIiILTEO T��ATER DISTRICT � � <br />�. -.. � i <br />��- S�p�o:�nsfi courTr, wasxixcTor <br />,�:, <br />;�'�PPLICATION FOR WATER <br />All Llnnks must Le filled in or crossed out <br />' . 194........ <br />,lisskiltco� Wxsh�nF on . .................................... <br />.................. .. <br />7'0 TSIF's SUPECI�"PPrDErT Ur THE NUI:iLT�O WATEF. DISTP.ICT: <br />I herebp ��PP�S for thc use. of �cuter in accordance with the rules nud reF�' <br />lations of thu D4uLilteo n'ateT Diatric:. <br />Uurin„ the Cimc that nnS n: tne «'ater mains ma}• be �=1cen up Uy rc:�son <br />ot ❑��}� imprucamr.nts antlioriud b}' `he Pistrict in or of ;mc street, road or <br />^llcy in �vh�ch the}• mav 6o`�e s ot such i`�proeements tu'an�tcotisumer� ��1�os�� <br />tm•nisn u•ater duriny; thc P FI' <br />suppl}� may thus he cuc oL`, or he. liaLle for anc dumage for its iailure .=.0 tu do. <br />� . � ................ � � <br />Applicunml No ...........................-.y..— . � <br />�--lK_.C.�l T � - <br />� /.. � � _.._ Add../)._..... ' ,�' <br />I31ocl :................................... .... Lot........................... ...... <br />. ............ ........ . . <br />., .� ,� -�- : <br />',`" .._�C.� i .ti:_� ....._..._..scr��t .... <br />_ 1.... / ...... .......:..-............... .. _.. <br />�o ....................._-. -�,I'... � <br />_ � � �, • <br />�, i ,. v-J 1 G ,� - a� J......._ , <br />.�,_.,,_C�' I ' _i . :...--........_..._............' ................................._�:......... <br />................................ ... - , <br />:.� . <br />/:_ �_ . ,�':�y:-....... � ..�:_r_�Z' <br />......_..... <br />_.... .. <br />................._._... ............. .. .. ^ <br />.................... � � <br />.. . � -i� - -r ��`-� <br />" � / ....incli. / % � � <br />State �ize of t��: .....,. _-,........ — <br />^'\,.....__........has Lean rcceived «•itii tLis aPplication. <br />� ........ __. .. <br />,.._._ � <br />` -; , �.i ' - s � <br />�J _........ <br />..............................,............................. ..........._.......... <br />� ,,. Si�pr,rtufcr�dciat. <br />� " ,.v'i� �rc <br />, � � �.�... <br />,�c pnnnises are eo Le used as u....._......... � �'y �......... <br />. ..... . .. <br />{)} . , -; " /{�.v��y 'ri N" <br />• ^v7..[�_ � �... C L t'.._ .............. <br />. . <br />'Che ow•ncr of tLe n.�emises �s...._....$i'..._ !'........ <br />_l..l. ...�.� ... .. <br />. ......................................... <br />....................... <br />Tiic agenc �s .................................................... <br />This spPlication, althnuch si�ued, shull not Ue Uinding uPon tnc llistrirt <br />imii] accepted Lc the SuPe'in�n<lent of. the �uLilteo R'ut District. <br />�i :'/�,/_�, :�_' ,, .. .,_ <br />'�_ . , ,.:x: �.:a._._-....O+mier. <br />. ....�.... <br />�\ Sif'ncd:�..:.: .....�:t.i........._ ................. . <br />:\cceptcd ....................................................19y._..... ES......_...............Su.prrintc,�Jeni <br />