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T�-iE �`ITY OF E�/EFZ� �T � , .: ,, , � <br />, ��,�, r r. � ,;, <br />� . . Date__6 }� �l . <br />. . . 1 _ C�- � I — Block / J � / <br />Sketch of Pronosed Sewer Cofnnection for Biuldinq Situated on LoL�-' " - - <br />Division or Addition i � / :!j, `[" � �/ r'�'.'� -- , • — <br />Nv._- .�..: �'�—: j! r� �T �/i � —Owned by� %1/.% !. ,��.✓�'/;-�4 ��-7 <br />Applica6on and Connection by— t U �`� - - /1--�r "'" H � ' '-r= 7'; � � 't� /�icen'se <br />� / � <br />Aemcn�3: _ / ---- <br />DepW o� Sewer a� Conna:4oa � <br />j��' � , <br />��t����SY,'` <br />\ ,. <br />� <br />� <br />� <br />Conneclion made the.-_�day of��S��� -- 19. �f�Ezamined and <br />_ ___ Supl. ol Streols and Sawme By- — <br />af— ._��' __Inspector 1 �� r� [) r) <br />�lt;.Ui. <br />� <br />/ 4 <br />Approved by_� � � � � �� � - -- <br />Ciry Gnqm�cr <br />l�� � ��r --- <br />� __ <br />