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\ <br />T�—i E C 1T � O� E�►f E R EiT Date --, �:, _-:_�=-� <br />- ' 1 i - � ' —. Block— <br />t tor Bui�din Situated on Lot__ .___— --.--- <br />Sketch of Proposed Sewer Connec ion . g <br />Division or Addilion > <br />; ` -• , , lv� / 1 ^ r � �' •-�� =j - <br />No.— c" � ` ? ` ..- �,7 -,� - � �. •9 ✓ Owned by-- <br />-1 ��-- _, <br />i� d r���y�.c�._,.t�� - - <br />Application and Connec6on �y �" � � � r�.Y7� ��`i�/. ra. ____ ._ _____I.icensee <br />C^ r <br />Rem�ka:— -- - �,. �. %� �/r•: /� :'� — _4�": �l �a'�'_--�•'- r�_� S ��' IJ �_—_ <br />Deplh o! Sewcr al Cannacllon � � I I � <br />I <br />3� <br />�',tsc.w.�T `t.�`, � �"'(.�.` <br />`�% A�`�' �.'�. <br />/" � � <br />i . <br />� , <br />S <br />�_ <br />'4 <br />r` <br />� I � I � <br />�/ �. 'O `'�-�-`+— ___.19_ 5 �. Examined und Approved by_ _1� .J � . �—j=-- '' � ' ` - - <br />Connection made che_—_P_ _— day oE —`"�""- , � c�ry Engincer <br />�r <br />` � t...r. _ � i /�: !-e.' ri�-. <br />_ `J���.�4'"�'x_.___ __.Supt. ot Streete and Sewan By—_—,f-. —'—` •--� <br />_—��i y _. _— � <br />Hy_ ______'—.— _!� .=-C.�_--. _— Innpacto� '- <br />��- �..�....._„� <br />I )v� J <br />� <br />