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THE �TY OF E'►�Et�E''�'" <br />Date �`�/�' 4� :' (-%S.> <br />S�etch of Proposed Sewer Cannection for Building Siivated on Lot_ �:�'_'.--__—__— B1ock � _ <br />llivision or Additio� `� " �' � ' --- <br />No.__��.+3 �� a � .,'l.i , :�'i "_r_i..i i -- <br />—Owned by <br />Application and Connection by � �' � , ' '� ^'' j°"""' � � ' — ----Licensee <br />Dept2� ot Sewei at Cowecllcn I <br />� <br />\' <br />� <br />� <br />Connection made the__-.—_day of _{ " 19 '—. Examined and Approved by �" ! I�,�Y Enqineer <br />c <br />.,. ! A i • rilvl <br />__— __—Suol. of Streele and Sewe�e By—__-_— — <br />$Y _ " � = � � ._Inepeclor 1 J J G p <br />t�� u�ee �.�� [u[ w wsu� ee: u�u <br />