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TPE C-,TY OF EVERE i f L <br />Date..__/ % a <br />Sketch of Proposed Sewer Connection for Building Situated on Lot --• ' ` l�'' ✓_._ Block <br />Division or Addition_ 1 - <br />No.�/�?-_Ownedby-- <br />Application and Connection by_ ,r i __ __ - �� _-_ -.__.Licensee <br />Remarks:- <br />Depth of Sewer at Comocllon <br />•�.�y, �, /INS\. y � <br />/1� to 1/f' .IMtA.�Wi <br />7 <br />Connection made the. A- A-kt-- day oL __ 19 . Examined and Appra ed by- /'- — %I-- - t.0 <br />% , City Engineer <br />--_—_-.SUPI. at Sheets and Sewers By_ ,,- '2-__;-. <br />By---- , ;----'`! - ----laspenlar 22546'• -- --_.- <br />