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y - _ . sai.L 1 1 <br />Sketch of Proposed Sewer Connection for Building Shunted on Lot- --- ----------------------- Block---------------- .. ---- <br />Div°sion or Addition---- ----- ------------------------------------------------------------- <br />No. -- -------Owned by -------------------------------- --Ir ----------- <br />Application and Connection by I Licensee <br />Remarks ----------------------------------- <br />Depth of Sewer at Connection <br />i/� <br />-------------------------------------------------------------------------- <br />I l� <br />! <br />.Nj <br />` \I <br />1 <br />C <br />Connection madethe__ dayof___---,-____191 Examined and Approved by_-: — ---- <br />-------------- <br />_ � <br />--___ _Supt. of Streets and Sewers Qfi�i 13' if 11 City Engineer. <br />-- - y - - <br />B --1 - ✓✓✓ ZQ----Inspector. By <br />