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V ERL f <br />Skctcii of Proposed Sewer Connection for Building Situated on Lot____ _____________ Block _____- /_2.r_________ <br />Divisionor Addition ------------ r------------------------------------------------------------- ---- <br />No. — ---------------------------- ----- -f � � "` ----------------- <br />Application <br />-�------ � � Owned by -- --- •�- and Connection by --- �C----- '_____-,..Ll__r_Z___'__I _- `� ---- -, ---------------------------------- Licensee <br />Remarks ----------------------- <br />Depth of Sewer at Connection I <br />L_ <br />------------------------------------------------------------------------------ <br />z <br />I � <br />Connection made the _da/ <br />y ti "_-----------191_-- Examined and Approved by - - -- - - <br />-__--_--(l ,-.._6 �___ „ C; ------- Supt. of Streets and Sewers <br />--Inspector. <br />i <br />G <br />0 6 2 b O City Engineer. <br />By---------------- <br />I = <br />r-- -- - -- - -- ---- <br />