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Sketch of Proposed Sewer onnection for Building Situated on Lot -------- !l-------------------- Block____ <br />Division or Addition__ _ ' �'�n - r --- <br />- - --- �a L1�--�'�.r� - -- ---- <br />-_-- --- ^^' -------------------- <br />No. _✓_ -�-/------- �� --� - - �- _ Owned b - ----- ---- - Application and connection by ----- �='�'�- y� _/�� <br />--' --- ---- -- -------------- Licensee <br />Remarks i <br />-------------------------------------- <br />Depth of Sewer at Connection <br />l ij <br />Connection made <br />1 <br />day of__/J1t1____ 191� . Examined and approved by <br />----- // w'7.] .1 p <br />' G_�__Supt, of Streets and Sewers By_ <br />---.Inspector - - <br />L <br />