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��J� �B✓ V��� �r e-'�i..I�dLI~':1� <br /> Skekh of Proposed Sewer Connection�{m• Building Situated on Lot / Block •- Y ' ' ---— <br /> Di��sion or Addition_ - --- <br /> ---- — <br /> No.__,_. ------ �� - - <br /> . , - � <br /> _ -- _ �—p�yn�d 6Y- . '"`_; " — <br /> _ � _ <br /> �. <br /> , ., •, -. _ . <br /> - - — _ _— <br /> APP���a'i�n and connection b;_ i � =� ` .-. �....- Licenscc <br /> , — -- <br /> Rec,arks.__ <br /> —-------------— <br /> _ —..----- --- <br /> � Depth of Sewer!3t Connection �I � I <br /> �!, �'� • �� <br /> -,- -- �'i ., � <br /> � ,— _�_ � . , � -"�t-- � <br /> ,��� ' <br /> � � I <br /> , ` , <br /> +�` � �� <br /> �., . . <br /> ,. .. <br /> , _� <br /> ' � ! I . <br /> �. <br /> _. _- --- --- -� <br /> � �.._ � v 3- -_.,;�� : <br /> ` . ;',� ���., <br /> � � <br /> i � -=�-,1. ---�- <br /> , -1 ;` ��. . _ i I <br /> Connection made the day of -� -�-�' � � � r 190 '�`. Esamined and approved by - .;% <br /> ' � �,�` Cit <br /> ;> Engineer <br /> �l�_;_;' ,�_-�G ���__� �—Supt. of Streets and Sewers. (�1�3 4�, •-By f'' " `y ' <br /> , BY---�`y .a- �'._ �, 1 , � i --Inspector. , -- - ' — --_— - ,_ , <br /> r . ---'�=--� <br />