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, <br /> ` J T�-IF� CIT:•' �� �V�Rr'T� �---� , <br /> Date � �' �/ �G'' <br /> ?.—,�— <br /> Ske'ch of Froposed Sewcr Connection for Building Situated on Lot—��-_-_______ $�ock—__ ' <br /> Division or Addition �' � •" �`� <br /> No. ' �.� �'_,: ' :i i:� ��(�f Owned by / � '� � �-, � <br /> Applica�and.Connection by_ � � Licensee <br /> Remarks: <br /> , Depth of Scwcr ac Connwr.on —_� I I <br /> �� <br /> I � �: , I <br /> ; I _--� — I <br /> � <br /> � �} <br /> � <br /> � —I <br /> �/. t. /- /��f ' � <br /> —c ��N <br /> / I <br /> � <br /> i i <br /> r ' <br /> �� I � j <br /> � � ; A <br /> '1 \ . I `\ ..,. <br /> \` � �N ( �� <br /> ; � ��, <br /> � <br /> i . .�--� ,�=-,,�-- <br /> � i <br /> � �- � <br /> Connection made the___ `-_day of_—_'_ 19.,�. Examined and Approved by F I = . <br /> . . ' .. Ciry Engincm <br /> . , Supi.of Strccts and Scwers py___ � � �i '.�/f^v' _ <br /> , ' ..� . �"._ <br /> —___ <br /> . B}' �'. • ,__' . '•� .� ,�,,'. ;�. r' ./� Inspectot <br /> �:000Ks e.ao.�e Rm�u�ea ' <br /> 1:1.;11:3 <br />