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THE UTY OF EVERE-1, <br />Date <br />Sketch of Proposed Sewer Connection for Building Sit..ated on Lot <br />Division or Addition__ G' ✓ <br />No.—, 3 o y a r'cs c .r <br />Application and Connection by 5'21 e <br />, t <br />Remarks:__5 A-, 1 F- <br />Depth of Sewer at Connection I <br />_J <br />"r. <br />/1 f <br />Connection made the. /= __day r,L— <br />Owned by fJ . '� 1� s7/ir� s <br />r, <br />_.Licensee <br />ISPit/r�r ""'ryj' -/ 2 y-v rr/ —/.c., :s I I <br />P-�c e��DraLr: lnib r'�l✓'�f <br />I <br />Examined and Ap roved by_ <br />__ I ._#i City Engineer <br />_Sopt. of Streets and Sewer, By_ - _ :" •+ �✓%-ter% +;-; <br />By ,-�6u1`_ _ .Inspector �_ <br />7 22J12 <br />