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T��� GI1'�' (�� TV�1�.�'1'.j. <br />Slcetch of Proposed Sca-er Connectin� ior BuildinG Situuted on I,ot__-'_ %._______ _________ $�oc1c__________ <br />•'� - _�-- --- <br />Div;sion or Additim�---,�1--, ---�---------------------------------------------------------------- <br />. , . .: _.,� .� � ------ <br />No ��_.� , � :� ( � -- <br />� � --------- <br />. f , � <br />-='--------'-�_='��-.---=�"-`-----=------------Owned U <br />. .--=--- ,: ., <br />y --` =-=--- -l�1�t ^___!.��%p'1.---'------- <br />• --------- <br />Application and Connection U,y----- --�'��1,�---_=Kl��, `-L-'=,t=.��(��--===--_ ==�--= '' . <br />1 _�1��--� --------------- Licensee <br />Remarks-------------�------------------------------------- — <br />Depth of Sewer nt Connection I <br />-!� ,�J / /j' � <br />(L <br />• 1/��. , �1'.'1..�. <br />" I I <br />i . <br />i <br />� . t.� !.a: _ ��. <br />;��' . ' '" ' . � !' "_ _ ' . _ . . _ I <br />I <br />~—'_ � <br />" ,�,-''i� 1"_�^ !�1 -. . _ _' . I <br />� <br />Connectiom m�de tl�c_ �-. _day,of _<_''/ -�' '_�____ 7g1 Exnmiucd and A� �oveci b ' ��' <br />C f -- y t l-' 3' -- — -j/ , ...,._, ,'� � <br />---- -� �� - � .::�' __Sunt, af Strcets and Sewers • � ' r <br />� , --, Ofi300 _ �, 'cieyEn, n��r. . <br />BY� , � t_�_ � �1� _� c i ,�-�S� -Inspector. By � � � r�_ ' �; �, <br />_ - r�-- - J --- E -�_ ,,�, <br />,, <br />' ' i` <br />-- - - - � -- <br />i; <br />