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'I'�IE C��'�' O� ��TERE� �.' � ,:��'�,,,. <br />�lch of Proposed Sewcr Connection for Building Si!uated an Lot _—� '--_--- f3locic—.---- -- <br />, Division o� Addition----`—'- —:-_---------------- -- ------ <br />No._ _-- — �------` �� o . � <,.� �.u/ , - Owned by — � .i :.i � �� ( �_r.- — — --- <br />� . ` � � <br />Application and Connection by— �� f— � ' ''/r � ____ __—Licensee <br />Rentar;cs:- ----- ------- <br />Depth of Sewer at Connectian I I 4 � <br />, <br />�1 � � <br />` ,i �,� <br />--- --= , -.. - � -- - _ _ , _.- _ _ _ _ �-- <br />/- - I <br />I ' <br />_J <br />--•� ---- :�- <br />� <br />) <br />�,,,,,"' <br />-- II-='� -f . . . . --;; - ,. -- -- i - <br />� � 08398 � � <br />Conneclion made fhe..'--.--dayof -_- .— -_ 191__ �xamined and Approved by----- - <br />� Gty L'��ginccr. <br />. _ _ _ ' _. . _ _ ____—_—Supt, of Sirecls and Sewers 6Y---------- --�— <br />-`�-- ;— <br />ii � . . I : , � � : . . . - Inspeclor . -- _ ____--__—..—_ _____ — <br />y� .___:�.� .__.._�_ � _.. ._ .�:_ ._._ . <br />