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�,� `. � J TH .� C1TY �F �V�F��TT <br /> ,�' :.: %�%d��,�"i'_ <br /> ' Date..�•T_ _- <br /> Skelch of Proposed Sewer Connr_ction tor Buildinq Situated on Lot_ _ _ � �— `�__. �''_ ___ Block �i".�_ -- <br /> � ! , <br /> • Division or Addiffoa_____���—_ --_.--__—_—.—._ _ — / <br /> ' No._�__�—_.: '� '"G'_'_r�c / — -----Owned by..—.�„�L�i� Gu iA�/i S p` ---- <br /> . � <br /> Applicafion and Connectioa by '1'1 '''f��'_�1'—...' >>_ _ _— _I.icensee <br /> �. • $ . / �^ J <br /> ' � � `iJ % ! r � r� �.'t"Y 1�i :- �� -, , : '= . F.- �. , i.` ;: �:{ .-��;�. C 1: ,S� c� /''�"' - �'/ !I`J L <br /> Rem�ka:— --=------- ' -—= <br /> :7 /, , . ` <br /> . Depth of Sawoc at Conneclion ��� I — � 1 <br /> L �.- <br /> � ::���. r . ''''� I <br /> I — --,;r t .�, . � <br /> � , <br /> � � "I ;�� <br /> - � �� . <br /> • � c ��titii��:.. . ;,��..�,�u `i��_ � � - <br /> � � � .:� � <br /> �� <br /> .I._�NtL1� !`ctit:-l. A-CIC�-L-V C�.l , I � � _._ <br /> l I <br /> :.i��;, .�<<-q� o� �_�;,�_<<:�-r( ,. � I � <br /> J � � � <br /> : � ��{< . <br /> I I <br /> I � <br /> � � I � <br /> � 1 _ s . � . <br /> Connection made the_��'—_day oi_— _--'__: �'-_-' __'"_>_19/. Examined and Approved by_. -.__�li_y ' ��!�'" <br /> � ,- �, - . J •'y" f- City Eng(nee� <br /> _ : t �. �. . '- -.. . — � f_ t:,., -1 C f• (I!�•..._ <br /> _ _ _--__ ..—.5___—________Supl. ol Stceele and Sewere Hy—_.^ .___ — <br /> Hy____—_�—�_ '_�_i _'___ --_—_ —_.Inepocto� ,1 V V U U <br /> .a�'°-�. ...�..�.._ << . <br /> . <br />