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SI�E 5��'v`�R P�R��'►!�' <br />�� a <br />6=i �CR�S3' :i?'�1�HP� D�STRlC€ <br />zz�o iaa�i s�. s.e. <br />Evcrefl, Wosh. 98."•.04 <br />=37-3647 <br />N° 15�)1 <br />� , <br />'fne u�:e:si�n�' O,vn�r he:cby r.��;e, appiice!ion fo a se.ver con�zc:ion to cev+er m-:in; of the Dist:ic?; <br />{or prcpe�ty c:esc-ib�c as foi ows �` <br />L=��1 De_cip`ion: <br />, '', <br />- � I ,J ; ". . . . <br />.A ':re>: <br />�M""-�� � � , <br />�r . ' 1 . <br />, « . , . <br />.._;..-�:�-' "__...-i...._�............ <br />.......:... - ......... --......... <br />�,s;c.s;,-en No ................... <br />�i <br />- . ;r I <br />Tir O rne- he:eby agrees to he bound by all <br />rui�, �r.d :eg r'ations, nc.v in ie-ce or es here- <br />� intf e�:nr��ed, of !n2 Se'�ver Cistrict. <br />� <br />...:.:...:... r.... _:....... ............ ;.. _.:................ - �--- �- �----- <br />� 0.+ ier s S�cnature <br />i, <br />%i i . <br />.� ......... .... .._ .... ... .... ...... .. ....... . ...... ... <br />....."__ _ .............' _.......... _....... _ _......""....'""""""" <br />........................... . <br />G,-�e=s P+iai;in_ Aadress <br />_..._...._._ . ... <br />..---• - ...._ ........... ............__... _........ •-� -�-- --- • <br />..... -'-........... . ...... . — .......... .....--- — <br />�i:linp Address <br />.. r� : : <br />Contrac.o-...,�,............'::;:.;.'s..:.:...:.':i.),:' ................_..........__.........Lican:e �lo... .._ - - _.._................._.......---.......-- <br />=�i.:; i �;r� I it�r,i .h: sh7 �"�e inSGeCic'd S)i u re�:e_en:a`ive of the 1i,�ri�i c�fo e coverin3. ih� prop- <br />e.;v c.vne: :i��l! b� e;.�on"Ibi� fr a�l ep�.o�icns, rroin :ncnce :.n :.euo;, cf +he si:'e -e�.;a.. <br />j -. <br />, ,� <br />Pc: ni: isue:: b�:%..:'..:.5�.�_.:....- � ....:.......:..:..:..:...'...:,...:7.__ __....................._.D:: e:....:..,::_.,..s:���_:..,<� _........... <br />�'_:' ' ; <br />