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.—�'1 ° c� THE :.ITY OF' �VER� f T - ~ � '� <br />. na�a ��,,,e �.�r-1�61 <br />5}:etch of P:. t�ed Sewer Connection for Buildinq Situaled on Lot— _-� _—_-- Block__—'— <br />Division or <br />l <br />Application and Connection <br />Dept6 ot Sa�er al ConnecUon I <br />�J <br />, <br />Licensee <br />:�-- <br />� <br />�� -� � � <br />�9�C ' �' �UlN _ , <br />Connection made the. __ __day oE__� _19. �. Exumined and Approved by_�_%__ <br />� _,� "t��,t ,Ll City Engiueer � <br />__ _______._.__Supl. ol Slrecle ond Sewere By—_— �. � �' <br />__. T _ _ _ <br />_—__._Inep¢clor 1 J 1 �S ~ t <br />By__. _ _ `�._.—__ —__- . <br />