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THE GI��1' Ol�' EV�RETT <br />_- -- -------� � '---- ----- <br />B�o�k <br />Slce�ch of Proposed Sewer Connect;o� for Building Siti�atad on ,ot__-------.---------- <br />----------- <br />-------- <br />, i <br />, , , ------------ <br />� ��_� ..,.. . / i. n�- -------------------- <br />. � , ... . ','- ...----------------, ------- <br />- - <br />Diviaior. or Addition-------- -----===�---`---------- _ <br />' ----Ownedby--------=---'-------`-`�--="^`---------------- ' <br />_:_. . _�---------------- <br />No. _ �__ � -= -�-------=--------- <br />,i !- L..-.. .___ .- --- --Y-1----------------------------------------- Licensee <br />Applicntion and connection by------------- --------��---"""' <br />--------------------- ------------ <br />------------------- --- <br />----- ------ <br />Remarks -------------- � � <br />Depth of Sewer at Connection I � I I <br />_ _' _ _ _ '_ ,� J � � . <br />- — �. <br />:(„�,.,,�_"1.,&-.... <br />� �� <br />/ .. .,. ,.-i � , <br />S <br />� <br />� � I . . . . I . .'� <br />/ . n � �_��_.:.-_ ,' '� ��----`----_./- -- <br />Connection made the___/ __-day of_____��- 1`�1`r �x��»lned and a proved by _-.�— �%` ; City Engincer <br />0721c� ' f % r �� <br />, /� / , _�7 r-r- � Ur� ;_i � �_:�_-. .- <br />�?_ ���__D�S'-c��•�S --------Snpt. o[ Streets and Sewers BY r `,� ` <br />_ - : � .� _.._ <br />, i; -) <br />� - <br />�/ , _ — ----r'---- <br />_ � -_ <br />i,,... t„ � ' -- <br />'� -"-�--`—`---'=--�'--`-- --`�----- Inspector <br />