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axetc� of Proposed �ewer Connecton for Bwlding Situated on Lot _._-__- _ _____ Block__ - <br />-- . �r---------� ---- <br />Livision or Addition_.. __ : / , � � . � i _. - <br />_ _ . -� - ' -.---- ----- - - <br />�, , � / r ---- -- - - ---- <br />No =-, = ---- � � -� J � �,- r .c ---- �Owned ny Frl_ 1 --- � --`�-r- =•z.� - - - - <br />Appl�catiwi and connection byv� _______� l ''^' �'� � <br />- -- ---- `�'-`�� -'� .--� -'��-- — -- Licensee <br />-- _�-�= ------ - <br />R,entarks -- -------------------------- - -- /----- -------- <br />--------------------- -------------- -- - <br />Deptli of Sewer at Connsction � I I I I I � <br />� _; -- � <br />� i <br />,:-. : . - — <br />� �I ,, l <br />C � <br />JJ <br />� <br />� <br />, . � <br />�..:� . , _.. <br />Q � . �� I , ,I �� , I � <br />Connectio/n - i1de the__!� 0 day of :�� � t J�r 1�J1.� Examine�'. and approved Uy__ ! � i_ __ , <br />/I� /�'/ � �� O % 1 rJ n _ � C�ty Engmeet� ' <br />.__:'.�1-�- ` f ---- � cs.-L�.. ? � � - � - <br />_ ____ _Supt. of Strec s and Sewers �'y __ � ____ _ __ _ _ _ <br />� � / ( ;' . �---� /.. �— <br />� y----` � ---C _---- '=�----- Inspector / � i . <br />� �w <br />