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TIDE UTY OF EVERE'. T / / ✓ <br />Date <br />Sketch of Proposed Sewer <br />Connection for Building Situated on Lot- Block___ <br />Division or Addition - <br />No. �---Owned— <br />Application and Connection y:5toqA"1r_I, __Licensee <br />3> Remarks:— _ _ _- I ' fa <br />Depth of Sower at Connection <br />4 <br />,rv"" <br />U.•0+�� <br />C <br />- S7 <br />Connection made the. tP _day oL_. n_t IA . Examined and Appro ed by_-_ <br />!/ City Engineer <br />— Sup6 Of Strests and Sewers <br />-inspector 22967 <br />