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THE C....iT Y OF EVERE i Itze <br />Date__ <br />Sketch of Proposed Sewer Connection for Building Situated on Lot <br />➢lock_ <br />Divicion or Addition_ - C I'll. l_£ _ /- r )) L% �-- <br />No.- <br />Owned by. L,_i.. <br />�A / -- — — — ---_Licensee <br />Application and Connection byy .y <br />Remarks:.�p---- <br />Depth of Saver vt Connection I I I <br />HN <br />C�h e;; <br />Connection made the- �` da of--_ _— _.---19"L• Examined and Approved <br />�___ y �Ctit . Engineer <br />`� ��o '-.r -� <br />--Supt. of Streets and Severe By---- <br />Inspector 22913 -- <br />L <br />