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TH� :[T'Y� OF E\/ERE :'T <br />Sl;��td� nE Proposed Sewez Connection for Build'uig Situated on Lot---- �• <br />Date i� t%, I_� ,/% J Z <br />Block-1_ _ <br />Diviuion ox Additio*+ <br />.,-� r C%.� r ""%'r �-T-.a !r '� L <br />No.__�_� (C:'o si � �� �. r_.: ; ' ------Owned by. I✓o i r _ _��__iLti s °' � -- <br />i / <br />Application and Connection by �`�� f 15 � % � � /" �'—�! t ""� �' ' --1.icensee <br />".' �'.: � r � d �'�� r �, �' –�, <br />Rem�ke: --�= '= <br />.� I � <br />� <br />Deplh o[ S�wer at Comectloa � I . ��I l�-"�T'.:,� . <br />� � <br />� I <br />. ���G <br />; �)(J I � r' � �S! <br />��at <br />� � I � <br />Connection made ihal `--day of_�—'•___�—___19—. Examined and Approved by__��:_ '�'. � v�'� <br />,..� / , 'J' / Clty Engineet <br />_ _ �fV •.� t l � : ��l , ___ Supt. ol SUeo1c and Sewere By— a..� ' ((�t, �/-��-^a� <br />� _ __.—_ <br />gY __ . � / --- _..JnepeNor 14 4 3 0 - - <br />w�1. u ee� �.o �uv � wca� m. usu <br />